Radiological Predictive Factors in the Healing of Displaced Intracapsular Hip Fractures. A Clinical Study of 404 Cases

Abstract

Background Fracture healing complications occur in approximately a third of displaced intracapsular hip fractures treated by reduction and internal fixation. Various radiographic features of the fracture have been used to estimate the risk of fracture healing complications. Aims: To determine which radiographic features of a displaced intracapsular hip fracture were the most reliable in predicting fracture re-displacement after internal fixation. Methods The pre-operative radiographs for 404 patients with a displaced intracapsular hip fracture treated by reduction and internal fixation were classified using five different variables. These were a direct measurement of trochanteric shortening and fracture shortening, a ratio of fracture displacement, the Garden grade and an alternative interpretation of the Garden grading. Inter-observer reliability of the various classifications was also studied. These observations were related to the later occurrence of fracture displacement or non-union. Results Only trochanteric shortening had an acceptable degree of inter-observer variation and this was also the most predictive of fracture re-displacement. The ratio method and fracture shortening were also related to fracture healing complications. Using the traditional Garden grading equal numbers of grade III and IV fractures healed but an alternative interpretation of the Garden grading showed some relationship to the development of non-union. Conclusions A direct measurement of shortening of the femur is the most reliable predictor of failure of the fracture to heal.