title: Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture.
abstract: Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%-19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60-101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality.
authors.affiliation: Calderdale and Huddersfield Foundation NHS Trust , UK.
authors.forename: O
authors.initials: O
authors.lastname: Riaz
authors.affiliation: Calderdale and Huddersfield Foundation NHS Trust , UK.
authors.forename: R
authors.initials: R
authors.lastname: Arshad
authors.affiliation: Calderdale and Huddersfield Foundation NHS Trust , UK.
authors.forename: S
authors.initials: S
authors.lastname: Nisar
authors.affiliation: Calderdale and Huddersfield Foundation NHS Trust , UK.
authors.forename: R
authors.initials: R
authors.lastname: Vanker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005271:Femur Head Necrosis / Q000209:etiology; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D057234:Preoperative Period; D012189:Retrospective Studies; D012709:Serum Albumin
chemical_list: D012709:Serum Albumin
keywords: Femoral neck fractures; Internal fracture fixation; Nutritional status; Serum albumin