title: Pre-operative nutritional serum parameters as predictors of failure after internal fixation in undisplaced intracapsular proximal femur fractures.
abstract: BACKGROUND
  Current management of undisplaced hip fractures is based on internal fixation. Reported revision rates of 12-17% for this procedure negatively impact on patient morbidity and mortality. The aim of this novel study is to examine if the nutritional status of these patients is associated with failure of internal fixation.
  
  
  METHODS
  A consecutive series of 111 undisplaced intracapsular hip fractures treated with cannulated screw was identified. These were retrospectively reviewed including routine admission serum investigations (lymphocyte count and albumin levels). Radiological investigations were used to assess fracture classification, posterior-tilt angle, fixation adequacy, screw configuration and failure (avascular-necrosis, non-union and screw cut-out).
  
  
  RESULTS
  16% of fixations failed (18 patients). Patients with fixation-failure had a significantly lower albumin (35g/l vs. 40g/l, p=0.02) and lymphocyte count (0.7×10(9)l vs. 1.4×10(9)l, p≤0.001) than non-failure patients. Lymphocyte count, albumin level and posterior-tilt angle were independent predicators of failure on binary logistic regression analysis. We suggest that routine laboratory tests can be used to identify patients at greatest risk of failure of internal fixation.
authors.affiliation: Trauma and Orthopaedic Department, Royal Glamorgan Hospital, Cwm Taf NHS Trust, United Kingdom.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bajada
authors.affiliation: Trauma and Orthopaedic Department, Royal Glamorgan Hospital, Cwm Taf NHS Trust, United Kingdom. Electronic address: adam.smith@doctors.org.uk.
authors.forename: Adam
authors.initials: A
authors.lastname: Smith
authors.affiliation: Trauma and Orthopaedic Department, Royal Glamorgan Hospital, Cwm Taf NHS Trust, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Morgan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005265:Femoral Neck Fractures / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D017211:Treatment Failure; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: Cannulated screw; Hip fracture; Nutrition