title: Metformin Prevents Nonunion after Three-Cannulated-Screw Fixation in Displaced Femoral Neck Fractures: A Retrospective Study.
abstract: Patients aged from 40 to 60 with displaced fractures of the femoral neck (Garden III or IV) who received fixation with three cannulated screws from January 2005 to December 2012 were evaluated retrospectively for the development of nonunion. Plasma HbA1C, a marker for long-term plasma glucose level, anti-T2DM medication, and other potential risk factors were recorded for the purpose of this study. There were no differences between the union and nonunion groups with respect to age, gender, Garden classification, Pauwel's angle, reduction quality, and T2DM presence. There were significant differences in reduction quality and preoperative plasma HbA1C level between patients with and those without union. The odds ratio (OR) for fracture nonunion was 2.659 (95% confidence interval [CI], 1.530-4.620) in subjects with anatomical reduction compared with those without anatomical reduction, 4.797 (95% CI, 1.371-16.778), in subjects with poor blood glucose control (HbA1C > 10%). The metformin usage showed a preventive effect on nonunion development (OR: 0.193 and CI: 0.060-0.616). The nonunion rate of metformin group (6.7%, 6/89) was even much lower than that of patients without T2DM (17.4%, 80/460).
authors.affiliation: Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
authors.forename: Xiao-Zhong
authors.identifier: 0000-0001-8796-5515
authors.initials: XZ
authors.lastname: Zhu
authors.affiliation: Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
authors.forename: Xian-You
authors.identifier: 0000-0002-9770-5394
authors.initials: XY
authors.lastname: Zheng
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000601:surgery; D005260:Female; D005265:Femoral Neck Fractures / Q000378:metabolism / Q000601:surgery*; D005272:Femur Neck / Q000378:metabolism / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods; D005599:Fractures, Ununited / Q000517:prevention & control* / Q000601:surgery*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008687:Metformin; C517652:hemoglobin A1c protein, human