title: Influence of time to surgery on the incidence of complications in femoral neck fracture treated with cannulated screws.
abstract: BACKGROUND
  Osteosynthesis of femoral neck fractures is particularly indicated in patients aged under 60 years. A prolonged interval between the fracture and surgical fixation has been associated with avascular necrosis (AVN) of the femoral head. The primary objective of this study was to evaluate the association between the time to surgery and the development of complications in patients with femoral neck fractures.
  
  
  METHODS
  Patients with displaced fractures of the femoral neck (Garden III or IV) who underwent fixation with three cannulated screws in the inverted triangle configuration from January 2009 to December 2010 were evaluated retrospectively for the development of orthopaedic complications. Patients were divided into two groups according to the time to surgery (within 7 days or more than 7 days). Complication rates were compared between the two groups. Regression analyses were performed to assess the risk factors for complications.
  
  
  RESULTS
  Thirty-one patients were included in the study; the duration of follow-up ranged from 24 to 50 months. The time from fracture to surgery ranged from 3 to 18 days. Fifteen patients underwent surgery within 7 days, and 16 patients underwent surgery after 7 days. There were four cases of femoral head necrosis. One patient had an associated infection; one patient experienced non-union, and another demonstrated osteosynthesis failure. There were no statistically significant differences in the overall rate of complications between the groups (p = 0.999). None of the preoperative parameters or fracture characteristics were predictive factors for complications. The only factor associated with the development of complications was inadequate fracture reduction in the anteroposterior (AP) view (odds ratio [OR] = 35.50, 95% confidence interval [CI] = 2.56 to 548.36, p = 0.008).
  
  
  CONCLUSIONS
  The interval between the occurrence of the injury and surgical fixation is not associated with the development of complications in fractures of the femoral neck. Inadequate fracture reduction in the AP view is a predictive factor for complications in these fractures.
authors.affiliation: Department of Orthopaedics and Traumatology, University of São Paulo, Brazil; Rua Ovidio Pires de Campos, São Paulo - SP, Brazil. Electronic address: thiegopedro@gmail.com.
authors.forename: Thiego Pedro Freitas
authors.initials: TP
authors.lastname: Araujo
authors.affiliation: Department of Orthopaedics and Traumatology, University of São Paulo, Brazil; Rua Ovidio Pires de Campos, São Paulo - SP, Brazil.
authors.forename: Tales Mollica
authors.initials: TM
authors.lastname: Guimaraes
authors.affiliation: Department of Orthopaedics and Traumatology, University of São Paulo, Brazil; Rua Ovidio Pires de Campos, São Paulo - SP, Brazil.
authors.forename: Fernando Brandao
authors.initials: FB
authors.lastname: Andrade-Silva
authors.affiliation: Department of Orthopaedics and Traumatology, University of São Paulo, Brazil; Rua Ovidio Pires de Campos, São Paulo - SP, Brazil.
authors.forename: Kodi Edson
authors.initials: KE
authors.lastname: Kojima
authors.affiliation: Department of Orthopaedics and Traumatology, University of São Paulo, Brazil; Rua Ovidio Pires de Campos, São Paulo - SP, Brazil.
authors.forename: Jorge Dos Santos
authors.initials: Jdos S
authors.lastname: Silva
mesh_terms: D000368:Aged; D001863:Bone Screws; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Avascular necrosis; Complications; Femoral neck fracture; Fracture fixation; Fracture reduction; Osteosynthesis; Time to surgery