![]() ![]() Variables showing statistical significance on univariate analysis were included in the multivariate logistic regression analysis, and the forward stepwise method was used to select variables that were eventually included in the model. A multiple logistic regression model was used to determine independent predictors of nonunion and reoperation. Pearson's chi-square test or Fisher's exact test for categorical variables and the independent Student's t-test or Mann-Whitney U-test for continuous variables were used to compare preoperative characteristics and surgical outcomes of each group. When nonunion or femoral head osteonecrosis with subsequent collapse was confirmed, hip arthroplasty was performed. Femoral head osteonecrosis with subsequent segmental collapse was diagnosed in patients who complained of pain and had simple radiographs showing cystic changes and focal bone radiolucency with more than 2 mm of femoral head collapse. Nonunion was defined when there was: 1) greater than 10 mm displacement, 2) progression to varus angulation, 3) greater than 5% change between the axis of the screws, 4) greater than 20 mm posterior translation, 5) femoral head perforation, or 6) no evidence of bone healing with significant hip pain after six months 15 16 17). ![]() For the radiologic evaluation, we assessed the incidence of nonunion and femoral head osteonecrosis with subsequent segmental collapse, and radiologic measurements, including articulo-trochanteric distance (ATD) index, and the sliding distance of the screws at the one-year follow-up, as reported by Yoon et al. The size of both lesser trochanters was matched to make a valid comparison of measured values.įor the clinical evaluation, we assessed the Harris hip score (HHS) and Palmer and Parker's mobility score at the one-year follow-up. AP radiographs of the pelvis were obtained with the patient in the supine position with both femurs internally rotated at 15°. ![]() The posterior tilt angle was assessed using Palm's method 4), measured as the angle between the mid-column line and the radius column line, which is drawn from the center of the caput circle to the crossing of the caput circle and the mid-column line ( Fig. The valgus angle was defined as the difference between these two angles (α–β). In the same way, the angle of the affected side was measured (α). We measured the angle formed by the line connecting the deepest point of the fovea centralis and the center of the femoral head and the longitudinal axis of the femoral shaft on the unaffected side (β). To measure the valgus angle, the femoral head center and the deepest point of the fovea centralis, which is a conspicuous and consistent anatomic landmark on the femoral head, were chosen. For the radiologic evaluation of preoperative deformity, the valgus angle and the posterior tilt angle were measured. Preoperative characteristics included sex, age, pre-injury mobility score, time from injury to operation, American Society of Anesthesiologists class, and body mass index 12 13). Preoperative characteristics were compared between the groups with and without nonunion and between the groups who had a reoperation or not.
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