Background: Reoperation of femoral neck fractures in elderly patients is frequent. Our aim was to determine predictors of reoperations following primary internal fixation with 3 cannulated screws.Materials and Methods: A follow-up study included all patients aged 65+ years old patients consecutively admitted to an orthopedic ward with femoral neck fracture in the period from January 1, 2007, to December 31, 2010, and fixed with cannulated screws. We retrospectively obtained all available data from patient databases related to potential predictors of reoperations: gender, age, dwelling, dementia, body mass index, vitamin D, albumin, prednisolone treatment, walking aid, performance of activities of daily living, low-energy trauma, initial displacement, and surgery quality. Outcome was reoperation due to fixation failure/prominent screws, nonunion, or avascular necrosis of femoral head within 2 years after surgery. By multivariate Cox proportional hazards regression, including mortality as a competing risk, we estimated crude and adjusted hazards ratios (HRs) with 95% confidence intervals (CIs) for reoperation.Results: Two years after surgery, 29% of 322 elderly patients underwent reoperation. Reoperation was associated with primary fracture displacement (HRadjusted 1.61; 95% CI: 1.01-2.55; P = .04) compared to undisplacement. A poor quality of primary reduction was associated with a higher risk of reoperations than a good quality (HRadjusted 1.95; 95% CI: 1.02-3.72; P = .04). Elderly individuals in own homes and sheltered housings had a higher risk of reoperation (HRadjusted 2.67; 95% CI 1.35-5.31; P = .005) compared to nursing home residents.Conclusion: Our findings support the evidence of a higher incidence of reoperation in displaced femoral neck fractures compared to the nondisplaced and is associated with poor quality of fracture reduction. Reoperations are most frequent in younger and more independent patients living at home.
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机译：背景：老年患者股骨颈骨折再手术频繁。我们的目的是确定使用3颗空心螺钉进行一次内固定后再手术的预测因素。材料和方法：随访研究包括所有65岁以上年龄在1月份开始连续入院并接受股骨颈骨折骨科病房治疗的患者。从2007年1月1日至2010年12月31日，并用空心螺钉固定。我们回顾性地从患者数据库中获得了所有与再次手术的潜在预测因素有关的数据：性别，年龄，居住，痴呆，体重指数，维生素D，白蛋白，泼尼松龙治疗，助行器，日常生活活动，低能量创伤，初始位移和手术质量。结果是在手术后2年内因固定失败/螺钉突出，骨不愈合或股骨头缺血性坏死而再次手术。通过多变量Cox比例风险回归（包括作为竞争风险的死亡率），我们以95％的置信区间（CI）估算了再次手术的粗略和调整后的危险比（HR）。结果：术后两年，在322名老年患者中有29％接受了再手术。与未移位相比，再次手术与原发性骨折移位相关（HR调整为1.61; 95％CI：1.01-2.55; P = .04）。与良好的质量相比，一次降低的质量较差与再次手术的风险更高（HR调整后的1.95; 95％CI：1.02-3.72; P = .04）。与疗养院居民相比，自有住房和庇护所中的老年人再次手术的风险更高（HR调整后的2.67; 95％CI 1.35-5.31; P = .005）。与未移位相比，移位的股骨颈骨折与骨折复位质量差有关。在家中较年轻且较独立的患者中，再手术最常见。
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