A Retrospective Study on the Relationship Between Calcar Femorale Injury and Postoperative Complications of Femoral Neck Fracture in Young and Middle-Aged Patients Treated With Three Cannulated Screws.

Abstract

Objectives: Given the critical biomechanical role of the calcar femorale in load transmission and fracture stability, understanding its relationship with postoperative complications is essential for optimizing surgical outcomes. Therefore, this study aimed to explore the relationship between calcar femorale injury and postoperative complications of femoral neck fracture in young and middle-aged patients.

Methods: A retrospective analysis was conducted on 350 femoral neck fracture patients (aged 18-65 years) treated with closed reduction and three cannulated screws fixation at a single institution from 2015 to 2020. Evaluate the clinical and imaging information of patients such as sex, age, body mass index, Garden classification, calcar femorale injury situation, computed tomography Hounsfield units (CT HUs), comorbidities (e.g., diabetes, hypertension etc.) and complications (femoral neck shortening, nonunion, and femoral head necrosis). CT-based 3D reconstruction was used to analyze calcar femorale morphology. Statistical analyses included univariate and multivariate logistic regression to identify independent risk factors.

Results: A total of 284 patients were included for analysis according to the inclusion and exclusion criteria. The results showed that Garden classification with displaced type (p < 0.001, OR = 4.615, 95% CI: 2.479-8.593), calcar femorale injury (p = 0.026, OR = 1.990, 95% CI: 1.087-3.645) and lower CT HUs (p = 0.002, OR = 0.989, 95% CI: 0.982-0.996) were independent risk factors for femoral neck shortening. Whether the patient has diabetes (p = 0.005, OR = 10.069, 95% CI: 2.043-49.628) was an independent risk factor for femoral neck nonunion. BMI (p = 0.030, OR = 1.154, 95% CI: 1.014-1.313) and Garden classification with displaced type (p < 0.001, OR = 10.000, 95% CI: 2.950-33.903) were independent risk factors for femoral head necrosis.

Conclusion: This study found that older patients with displaced type femoral neck fractures with calcar femorale injury are more likely to experience femoral neck shortening. Clinicians should pay close attention to the above risk factors to reduce the incidence of postoperative complications in young and middle-aged patients with femoral neck fractures.