ORIGINAL ARTICLE

Open Access

The Failure Rate of Internal Fixation Increases With Sagittal Displacement of the Femoral Head: A Retrospective Study

Lei Shi,

Lei Shi

orcid.org/0000-0002-6728-770X

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

Medical School of Chinese PLA, Beijing, China

Contribution: Conceptualization (equal), Data curation (lead), Formal analysis (lead), Writing - original draft (lead)

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Chen Chen,

Chen Chen

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

Contribution: Data curation (equal), Formal analysis (equal), Software (lead), Visualization (lead), Writing - original draft (equal)

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Junsong Wang,

Junsong Wang

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China

Contribution: Conceptualization (equal), Data curation (equal), Investigation (equal), Methodology (equal), Software (equal), Supervision (equal)

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Yuanhao Wu,

Yuanhao Wu

Department of Orthopedics, Qujing No.1 Hospital, Qujing, China

Contribution: Data curation (equal), Resources (equal), Software (equal), Visualization (equal)

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Jia Li,

Corresponding Author

Jia Li

[email protected]

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China

Correspondence: Jia Li ([email protected])

Houchen Lyu ([email protected])

Quanyi Guo ([email protected])

Contribution: Funding acquisition (equal), Investigation (equal), Methodology (equal), Project administration (lead), Resources (equal), Supervision (equal), Writing - review & editing (lead)

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Houchen Lyu,

Corresponding Author

Houchen Lyu

[email protected]

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China

Correspondence: Jia Li ([email protected])

Houchen Lyu ([email protected])

Quanyi Guo ([email protected])

Contribution: Conceptualization (equal), Funding acquisition (lead), Investigation (equal), Project administration (equal), Resources (lead), Supervision (equal), Writing - review & editing (equal)

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Quanyi Guo,

Corresponding Author

Quanyi Guo

[email protected]

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

Key Lab Musculoskeletal Trauma & War Injuries PLA, Inst Orthoped, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China

Correspondence: Jia Li ([email protected])

Houchen Lyu ([email protected])

Quanyi Guo ([email protected])

Contribution: Methodology (equal), Project administration (lead), Resources (equal), Software (equal), Supervision (lead)

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Peifu Tang,

Peifu Tang

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China

Contribution: Project administration (lead), Supervision (lead), Writing - review & editing (equal)

Search for more papers by this author

Lei Shi,

Lei Shi

orcid.org/0000-0002-6728-770X

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

Medical School of Chinese PLA, Beijing, China

Contribution: Conceptualization (equal), Data curation (lead), Formal analysis (lead), Writing - original draft (lead)

Search for more papers by this author

Chen Chen,

Chen Chen

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

Contribution: Data curation (equal), Formal analysis (equal), Software (lead), Visualization (lead), Writing - original draft (equal)

Search for more papers by this author

Junsong Wang,

Junsong Wang

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China

Contribution: Conceptualization (equal), Data curation (equal), Investigation (equal), Methodology (equal), Software (equal), Supervision (equal)

Search for more papers by this author

Yuanhao Wu,

Yuanhao Wu

Department of Orthopedics, Qujing No.1 Hospital, Qujing, China

Contribution: Data curation (equal), Resources (equal), Software (equal), Visualization (equal)

Search for more papers by this author

Jia Li,

Corresponding Author

Jia Li

[email protected]

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China

Correspondence: Jia Li ([email protected])

Houchen Lyu ([email protected])

Quanyi Guo ([email protected])

Contribution: Funding acquisition (equal), Investigation (equal), Methodology (equal), Project administration (lead), Resources (equal), Supervision (equal), Writing - review & editing (lead)

Search for more papers by this author

Houchen Lyu,

Corresponding Author

Houchen Lyu

[email protected]

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China

Correspondence: Jia Li ([email protected])

Houchen Lyu ([email protected])

Quanyi Guo ([email protected])

Contribution: Conceptualization (equal), Funding acquisition (lead), Investigation (equal), Project administration (equal), Resources (lead), Supervision (equal), Writing - review & editing (equal)

Search for more papers by this author

Quanyi Guo,

Corresponding Author

Quanyi Guo

[email protected]

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

Key Lab Musculoskeletal Trauma & War Injuries PLA, Inst Orthoped, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China

Correspondence: Jia Li ([email protected])

Houchen Lyu ([email protected])

Quanyi Guo ([email protected])

Contribution: Methodology (equal), Project administration (lead), Resources (equal), Software (equal), Supervision (lead)

Search for more papers by this author

Peifu Tang,

Peifu Tang

Department of Orthopedics, Chinese PLA General Hospital, Beijing, China

National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China

Contribution: Project administration (lead), Supervision (lead), Writing - review & editing (equal)

Search for more papers by this author

First published: 30 June 2025

https://doi.org/10.1002/hcs2.70022

Lei Shi and Chen Chen contributed equally to this study.

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ABSTRACT

Background

The risk of internal fixation failure remains relatively high in stable femoral neck fracture (FNF) (Garden I or II). Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor. This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation (CSIF) in patients with stable FNF (Garden I or II) by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography (CT) imaging.

Methods

This study included 167 patients with FNF who underwent CSIF. The sagittal tilt angle of the femoral head (STAFH) was evaluated using three-dimensional CT (3D-CT). The distribution of preoperative STAFH was analyzed, and its independent association with treatment failure was assessed. Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis, nonunion, or internal fixation failure.

Results

Among the 167 patients, 9 (5.4%) exhibited anterior tilt (AT) of the femoral head, 158 (94.60%) presented with posterior tilt (PT). A total of 50 patients (29.9%) demonstrated excessive sagittal displacement (AT ≥ 10° or PT ≥ 20°). In the failure group, 80.0% of patients had excessive sagittal displacement compared to 28.1% in the healed group. Excessive sagittal displacement was significantly associated with an increased risk of surgical failure (odds ratio: 11.953, 95% CI: 3.656–39.083, p < 0.05).

Conclusions

In patients with Garden I or II FNF, greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure. AT ≥ 10° or PT ≥ 20° were identified as independent predictors of CSIF failure in FNF patients. Nevertheless, these findings still require confirmation through prospective, multi-center clinical trials with large sample sizes.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author.

Supporting Information

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The Failure Rate of Internal Fixation Increases With Sagittal Displacement of the Femoral Head: A Retrospective Study

ABSTRACT

Background

Methods

Results

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

Figures

References

Information

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The Failure Rate of Internal Fixation Increases With Sagittal Displacement of the Femoral Head: A Retrospective Study

ABSTRACT

Background

Methods

Results

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

Figures

References

Related

Information