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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 11, 1487-1494.
doi: 10.1302/0301-620X.90B11.20582  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip

A MULTI-CENTRE COHORT STUDY

M. Zlowodzki, MD, Orthopaedic Surgery Resident1; O. Brink, MD, PhD, MPA, Orthopaedic Surgeon, Assistant Professor2; J. Switzer, MD, Orthopaedic Surgeon, Assistant Professor1; S. Wingerter, MD, Orthopaedic Surgery Resident3; J. Woodall, Jr, MD, Orthopaedic Surgery Resident3; B. A. Petrisor, MD, MSc, Orthopaedic Surgeon, Assistant Professor4; P. J. Kregor, MD, Orthopaedic Surgeon, Associate Professor5; D. R. Bruinsma, MD, Resident4; and M. Bhandari, MD, MSc, Associate Professor4

1 University of Minnesota, 2450 Riverside Avenue S, R200, Minneapolis, Minnesota 55454, USA.
2 Aarhus University, Nørrebrogade 44, 8000 Aarhus C, Denmark.
3 University of Mississippi 2500 N. State Street, Jackson, Mississippi 39216, USA.
4 Canada Research Chair Hamilton General Hospital, 7 North, Suite 727, 237 Barton Street, Hamilton, Ontario L8L 2X2, Canada.
5 Division of Orthopaedic Trauma Vanderbilt University Medical Center, 131 Medical Center South, 2100 Pierce Avenue, Nashville, Tennessee 37232-3450, USA.

Correspondence should be sent to Dr M. Zlowodzki; e-mail: zlowo001{at}umn.edu

We have studied the effect of shortening of the femoral neck and varus collapse on the functional capacity and quality of life of patients who had undergone fixation of an isolated intracapsular fracture of the hip with cancellous screws. After screening 660 patients at four university medical centres, 70 patients with a mean age of 71 years (20 to 90) met the inclusion criteria. Overall, 66% (46 of 70) of the fractures healed with > 5 mm of shortening and 39% (27 of 70) with > 5° of varus. Patients with severe shortening of the femoral neck had significantly lower short form-36 questionnaire (SF-36) physical functioning scores (no/mild (<5 mm) vs severe shortening (> 10 mm); 74 vs 42 points, p < 0.001). A similar effect was noted with moderate shortening, suggesting a gradient effect (no/mild (< 5 mm) vs moderate shortening (5 to 10 mm); 74 vs 53 points, p = 0.011). Varus collapse correlated moderately with the occurrence of shortening (r = 0.66, p < 0.001). Shortening also resulted in a significantly lower EuroQol questionnaire (EQ5D) index scores (p = 0.05). In a regression analysis shortening of the femoral neck was the only significant variable predictive of a low SF-36 physical functioning score (p < 0.001).






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General