Early Radiographic Union Score for Hip Is Predictive of Femoral Neck Fracture Complications Within 2 Years

the FAITH Investigators

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)

Abstract

Objectives:To determine if the Radiographic Union Score for Hip (RUSH) measured at 3 and 6 months after femoral neck fracture were predictive of reoperation for infection, nonunion, delayed union, avascular necrosis, or implant failure within 24 months of initial surgery.Design:Secondary analysis of a randomized controlled trial. Logistic regression was performed to investigate associations between lower RUSH and reoperation. Results were reported as odds ratios (OR), 95% confidence intervals (CIs), and associated P values. All tests were 2 tailed with alpha = 0.05.Setting:Eighty-one clinical sites across 8 countries.Patients/Participants:Data from 734 of the clinical trial participants with radiographs at 3 and 6 months after fracture fixation were included.Intervention:A reviewer blinded to patients' outcomes independently assigned a RUSH at each follow-up time point.Main Outcome Measures:Revision surgery rate related to intervention.Results:Lower RUSH at 3 and 6 months were associated with increased odds of reoperation within 24 months of fracture fixation. For every 2-point decrease in RUSH at 3 months, there was a 16% increase in the odds of a patient experiencing a re-operation (OR, 1.16; 95% CI, 1.10-1.22; P < 0.0001). A similar association was observed at the 6-month assessment for every 2-point decrease (OR = 1.05; 95% CI, 1.01-1.09; P = 0.005).Conclusions:Decreased radiographic healing as early as 3 months post fracture fixation is associated with developing patient important femoral neck fracture reoperations. This relationship may guide early treatment decisions, suggesting that 3- and 6-month RUSH are a useful surrogate measure of reoperations within 24 months of fracture fixation.Level of Evidence:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)E195-E202
JournalJournal of Orthopaedic Trauma
Volume34
Issue number6
DOIs
Publication statusPublished - 1 Jun 2020
Externally publishedYes

Bibliographical note

Funding Information:
M. Bhandari reports grants from Canadian Institutes of Health Research, grants from Stichting NutsOhra, grants from the Netherlands Organisation for Health Research and Development, and grants from Physicians' Services Incorporated during the conduct of the study, personal fees from AgNovos Healthcare, personal fees and non-financial support from Sanofi Aventis, personal fees from Stryker, personal fees from Pendopharm, grants from DJ Orthopedics, grants from Acumed, outside the submitted work. M. Swiontkowski reports board or committee member of the American Orthopaedic Association, consultant to the Minnesota Board of Medical Practice, editorial or governing board, publishing royalties, financial or material support from the Journal of Bone and Joint Surgery–American, publishing royalties, financial or material support from Saunders/Mosby-Elsevier, and publishing royalties, financial or material support from Wolters Kluwer Health - Lippincott Williams & Wilkins, outside the submitted work. G. P. Slobogean reports grants other from Journal of Orthopaedic Trauma, other from Orthopaedic Trauma Association, grants from Patient Centered Outcomes Research Institute, personal fees from Smith & Nephew, grants from US Department of Defense, personal fees from Zimmer, outside the submitted work. S. Sprague reports personal fees from Global Research Solutions, personal fees from University of Sherbrooke, personal fees from Dartmouth University, personal fees from University of Maryland, outside the submitted work. The remaining authors have nothing to disclose.

Funding Information:
The FAITH Study was supported by research grants from the Canadian Institutes of Health Research (MOP-106630 and MCT-87771), National Institutes of Health (1R01AR055267-01A1), Stichting NutsOhra (SNO-T-0602-43), the Netherlands Organisation for Health Research and Development (80-82310-97-11032), and Physicians' Services Incorporated. M. Bhandari was also funded, in part, through the Early Research Award Program which provided funding for the FAITH study and by a Canada Research Chair in Musculoskeletal Trauma, which is unrelated to the FAITH study (McMaster University, Hamilton, ON, Canada). Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number 1R01AR055267-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Research reported in this publication was also supported by The County Durham and Tees Valley Comprehensive Local Research Network, which operates as part of the National Institute for Health Research Comprehensive Clinical Research Network in England. The funding sources had no role in design or conduct of the FAITH study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript.

Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.

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