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Radiographic prevalence of CAM-type femoroacetabular impingement after open reduction and internal fixation of femoral neck fractures

  • Hip
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to estimate the radiographic prevalence of CAM-type femoroacetabular impingement (FAI) in elderly patients (≥50 years) who have undergone internal fixation for femoral neck fracture.

Methods

A total of 187 frog-leg lateral radiographs of elderly patients who underwent internal fixation for a femoral neck fracture were reviewed by two independent reviewers. The alpha angle, beta angle, and femoral head–neck offset ratio were calculated. The presence of two abnormal radiographic parameters was deemed to be diagnostic of radiographic CAM-type impingement.

Results

Radiographic CAM-type FAI was identified in 157 out of 187 (84 %) patients who underwent internal fixation for fractures of the femoral neck. Moderate-to-good inter-observer reliability was achieved in the measurement of radiographic parameters. With reference to fracture subtypes and prevalence of radiographic features of CAM-type morphology, 97 (72 %) out of 134 patients were positive for CAM in Garden subtypes I and II, whereas 49 (85.9 %) out of 57 patients had radiographic CAM in Garden III and IV subtypes.

Conclusion

There was a high prevalence of CAM-type FAI in patients that underwent surgical fixation of femoral neck fractures. This is significantly higher than the reported prevalence in non-fracture patient populations. The high prevalence of CAM morphology could be related to several factors, including age, fracture morphology, quality of reduction, type of fixation, and fracture healing.

Level of evidence

IV.

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Conflict of interest

The authors declare they have no conflict of interest.

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Authors and Affiliations

Authors

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Corresponding author

Correspondence to O. R. Ayeni.

Appendices

Appendix A: Fixation using alternative implants for the treatment of hip fractures (FAITH) trial patient inclusion and exclusion criteria

Inclusion criteria

  • Adult men or women aged 50 years and older (with no upper age limit).

  • Fracture of the femoral neck confirmed with either anteroposterior and lateral hip radiographs, computed tomography, or magnetic resonance imaging (MRI).

  • Operative treatment of displaced fractures within 4 days of presenting to the emergency room.

  • Operative treatment of undisplaced fractures within 7 days of presenting to the emergency room.

  • Patient was ambulatory prior to fracture, though they may have used an aid such as a cane or a walker.

  • Anticipated medical optimalization for operative fixation of the hip.

  • Provision of informed consent by patient or legal guardian.

  • No other major trauma (defined as an Injury Severity Score >16).

  • Low-energy fracture, in the judgment of the attending surgeon.

Exclusion criteria

  • Patients not suitable for internal fixation (i.e. severe osteoarthritis, rheumatoid arthritis, or pathologic fracture).

  • Associated major injuries of the lower extremity (i.e. ipsilateral or contralateral fractures of the foot, ankle, tibia, fibula, knee, or femur; dislocations of the ankle, knee, or hip; or femoral head defects or fracture).

  • Retained hardware around the affected hip.

  • Infection around the hip (i.e. soft tissue or bone).

  • Patients with disorders of known bone metabolism except osteoporosis (i.e. Paget’s disease, renal osteodystrophy, osteomalacia).

  • Patients with a history of frank dementia that would interfere with assessment of the primary outcome (i.e. revision surgery at 2 years).

  • Likely problems, in the judgment of the investigators, with maintaining follow-up (i.e. patients with no fixed address report a plan to move out of town, or intellectually challenged patients without adequate family support).

Exclusion of a patient because of enrolment in another ongoing drug or surgical intervention trial will be left to the discretion of the attending surgeon, on a case-by-case basis.

Appendix B: FAITH Study Authorship

Research grants were received from the following: Canadian Institutes of Health Research (CIHR) (PI: Mohit Bhandari); National Institutes of Health (NIH) (PI: Marc Swiontkowski); Stichting NutsOhra (PI: Martin J. Heetveld), The Netherlands Organisation for Health Research and Development (PI: Esther M.M. Van Lieshout); Physicians’ Services Incorporated (PI: Mohit Bhandari). Dr. Bhandari was also funded, in part, by a Canada Research Chair in Musculoskeletal Trauma which is unrelated to the present study (McMaster University, Hamilton, ON, Canada). The funding sources had no role in design or conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript. Dr. Mohit Bhandari had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Steering Committee:

Mohit Bhandari (Chair), Marc Swiontkowski, Philip J. Devereaux, Gordon Guyatt, Martin J. Heetveld, Kyle Jeray, Susan Liew, Emil H. Schemitsch, Lehana Thabane, Stephen Walter.

Global Methods Centre:

Mohit Bhandari (Principal Investigator); Sheila Sprague (Research Program Manager); Taryn Scott, Marilyn Swinton, Helena Viveiros (Research Coordination); Diane Heels-Ansdell, Qi Zhou (Statistical Analysis); Lisa Buckingham, Aravin Duraikannan (Data Management); Deborah Maddock (Grants Manager) (McMaster University).

US Methods Centre:

Marc Swiontkowski (Principal Investigator); Julie Agel (Research Coordination) (University of Minnesota).

Netherlands Method Centre:

Martin J. Heetveld (Principal Investigator); Esther M.M. Van Lieshout (Research Coordination); Stephanie M. Zielinski (Trial Coordination) (Erasmus MC, University Medical Center Rotterdam).

Central Adjudication Committee:

Gregory J Della Rocca (Chair), Robert Haverlag, Susan Liew, Gerard Slobogean.

Data Safety Monitoring Board:

Jeffrey Katz (Chair), Brenda Gillespie, Gail A. Greendale, Pierre Guy, Curtis Hartman, Craig Rubin, James Waddell.

Clinical Site Investigators

The following persons participated in the FAITH Study:

Canada:

Robert McCormack, Kelly Apostle, Dory Boyer, Farhad Moola, Bertrand Perey, Trevor Stone, Darius Viskontas, H. Michael Lemke, Mauri Zomar, Karyn Moon, Raely Moon, Amber Oatt (Royal Columbian Hospital); Richard E. Buckley, Paul Duffy, Robert Korley, Shannon Puloski, Kelly Johnston, James Powell, Kimberly Carcary (Foothills Medical Centre); David Sanders, Abdel Lawendy, Christina Tieszer (London Health Sciences Centre); David Stephen, Hans Kreder, Richard Jenkinson, Markku Nousiainen, Terry Axelrod, John Murnaghan, Diane Nam, Robin Richards, Sebastian Rodriguez-Elizalde, Veronica Wadey, Albert Yee, Katrine Milner, Monica Kunz, Melanie MacNevin, Ria Cagaanan (Sunnybrook Health Sciences Centre); Emil H. Schemitsch, Henry Ahn, Jeremy A Hall, Michael D McKee, Daniel B Whelan, Aaron Nauth, Milena Vicente, Lisa Wild, Ryan Khan, Jennifer Hidy (St. Michael’s Hospital); Chad Coles, Ross Leighton, Michael Biddulph, David Johnston, Mark Glazebrook, David Alexander, Cathy Coady, Michael Dunbar, Kelly Trask, Shelley MacDonald, Gwen Dobbin (Queen Elizabeth II Health Sciences Centre); Ryan Bicknell, Jeff Yach, Davide Bardana, Gavin Wood, Mark Harrison, David Yen, Sue Lambert, Fiona Howells, Angela Ward (Human Mobility Research Centre, Queen’s University and Kingston General Hospital); Paul Zalzal, Heather Brien, V. Naumetz, Brad Weening, Nicole Simunovic (Oakville Trafalgar Memorial Hospital); Eugene K. Wai, Wade T. Gofton, Stephen P. Kingwell, Allen Liew, Steve Papp, Garth Johnson, Joseph O’Neil, Darren M. Roffey, Vivian Borsella (Ottawa Hospital); Victoria Avram (Juravinski Hospital and Cancer Centre).

United States:

Todd M. Oliver, Vicki Jones (Boone Hospital Center – Columbia Orthopaedic Group); Clifford Jones, James Ringler, Terrence Endres, Debra L. Sietsema (Orthopaedics Associates of Michigan); Kyle J. Jeray, J. Scott Broderick, David R. Goetz, Thomas B. Pace, Thomas M. Schaller, Scott E. Porter, Stephanie L. Tanner, Rebecca G. Snider, Lauren A. Nastoff, Shea A. Bielby (Greenville Hospital System); Andrew J Marcantonio, Richard Iorio, John Garfi (Lahey Clinic); Julie A. Switzer, Peter A. Cole, Sarah A. Anderson, Paul M. Lafferty, Mengnai Li, Thuan V. Ly, Scott B. Marston, Amy L. Foley, Sandy Vang, David M. Wright (Regions Hospital-University of Minnesota); Michael J. Prayson, Richard Laughlin, Joseph Rubino, Jedediah May, Geoffrey Ryan Rieser, Liz Dulaney-Cripe, Chris Gayton (Miami Valley Hospital); Heather A. Vallier, Andrea Dolenc, Chalitha Robinson (MetroHealth Medical Center); James Shaer, Tyson Schrickel, Barbara Hileman (St. Elizabeth Health Center); John T. Gorczyca, Jonathan M. Gross, Catherine A. Humphrey, Stephen Kates, Krista Noble, Allison W McIntyre, Kaili Pecorella (University of Rochester Medical Center); Craig A. Davis, Stewart Weinerman, Peter Weingarten, Philip Stull, Stephen Lindenbaum, Michael Hewitt, John Schwappach, Janell K. Baker (Colorado Orthopedic Consultants); Samir Mehta, John Esterhai, Jaimo Ahn, Annamarie D. Horan, Kelly McGinnis, Christine A. Kaminski, Brynn N. Kowalski (University of Pennsylvania); Lisa K. Cannada, David Karges, Leslie Hill (St. Louis University Hospital); Ivan Tarkin, Peter Siska, Gary Gruen, Andrew Evans, Dana J. Farrell, James Irrgang, Arlene Luther (University of Pittsburgh Medical Center); Jonathan P. Keeve, Christopher G. Anderson, Michael D. McDonald, Jodi M. Hoffman (Northwest Orthopaedic Specialists); Mark Jenkins, Jules Dumais, Amanda W. Romero (Texas Tech University Health Sciences Center – Lubbock); Joseph R. Hsu, James Ficke, Michael Charlton, Matthew Napierala, Mary Fan (US Army Institute of Surgical Research); William W. Cross III, Joseph R. Cass, Stephen A. Sems, Michael E. Torchia, Tyson Scrabeck (Mayo Clinic); Carlos A. Sagebien, Mark S. Butler, James T. Monica, Patricia Seuffert (University Orthopaedic Associates, LLC); Paul Tornetta III, Hope Carlisle, Heather Silva (Boston University Medical Center); Michael Archdeacon, Ryan Finnan, Toan Le, John Wyrick, Shelley Hess (UC Health/University of Cincinnati Medical Center); Michael L. Brennan, Robert Probe, Evelyn Kile, Kelli Mills, Lydia Clipper, Michelle Yu, Katie Erwin (Scott and White Memorial Hospital); Jessica McBeth (Santa Clara Valley Medical Center); Kamran Aurang, Gary Zohman, Brett Peterson, Roger B. Huff (Kaiser Permanente); Andrew H. Schmidt, Jerald R. Westberg (Hennepin County Medical Center); Joseph Baele, Timothy Weber, Matt Edison (OrthoIndy); Charles J. DePaolo, Rachel Alosky, Leslie E. Shell, Lynne Hampton, Stephanie Shepard, Tracy Nanney, Claudine Cuento (Mission Hospital Research Institute); Karl Shively, Janos P. Ertl, Brian Mullis, J. Andrew Parr, Ripley Worman, Valda Frizzell, Molly M. Moore, Erin Tobias, Emily Thomas (Indiana University – Wishard Health Services); David P. Zamorano, Deeba Pourmand, Deanna Lawson (University of California Irvine Medical Center); E. Mark Hammerberg, Philip Stahel, David Hak, Cyril Mauffrey, Douglas Gibula, Hannah Gissel, Corey Henderson (Denver Health Medical Center); Robert V. Cantu, Eric R. Henderson, Linda S. Eickhoff (Dartmouth-Hitchcock Medical Center); Daniel Horwitz, Kent Strohecker, Teresa K. Swenson (Geisinger Medical Center); Gregory J. Della Rocca, Brett D. Crist, Yvonne M. Murtha, Melinda McPherson, Linda K. Anderson (University of Missouri Health Care); Michael P. Dohm, Abby Zellar (Western Slope Study Group); Colleen Linehan, Lindsey Pilling (Covenant Healthcare of Saginaw) Courtland G. Lewis, Stephanie Caminiti, Raymond J. Sullivan, Elizabeth Roper (University of Connecticut – Hartford Hospital); William Obremskey, Philip Kregor, Justin E. Richards, Kenya Stringfellow (Vanderbilt University Medical Center).

The Netherlands:

J. Carel Goslings, Robert Haverlag, Kees Jan Ponsen (Academic Medical Center); Maarten W.G.A. Bronkhorst, Onno R. Guicherit (Bronovo Ziekenhuis); Peter Patka, Martin G. Eversdijk, Rolf Peters, Dennis Den Hartog, Oscar J.F. Van Waes, Pim Oprel (Erasmus MC, University Medical Center Rotterdam); Piet A.R. de Rijcke, Cees L. Koppert, Steven E. Buijk, Richard P.R. Groenendijk, Imro Dawson, Geert W.M. Tetteroo, Milko M.M. Bruijninckx, Pascal G. Doornebosch, Eelco J.R. de Graaf (IJsselland Ziekenhuis); Martin J. Heetveld, Gijs A. Visser, Heyn Stockmann, Rob Silvis, Jaap P. Snellen, Bram Rijbroek, Joris J.G. Scheepers, Erik G.J. Vermeulen, Michiel P.C. Siroen, Ronald Vuylsteke, Hans L.F. Brom, Herman Rijna (Kennemer Gasthuis); Gert R Roukema, Hong A. Josaputra, Paul Keller, Peter D. de Rooij, Hans Kuiken, Han Boxma, Berry I. Cleffken, Ronald Liem (Maasstad Ziekenhuis); Steven J. Rhemrev, Coks H.R. Bosman, Alexander de Mol van Otterloo, Jochem Hoogendoorn, Alexander C. de Vries, Sven A.G. Meylaerts (Medisch Centrum Haaglanden); Rudolf W. Poolman, Maarten P. Simons, Frank H.W.M. van der Heijden, W. Jaap Willems, Frank R.A.J. de Meulemeester, Cor P. van der Hart, Kahn Turckan, Sebastiaan Festen, Frank de Nies, Robert Haverlag, Nico J.M. Out, Jan Bosma (Onze Lieve Vrouwe Gasthuis); Maarten van der Elst, Carmen C. van der Pol, Martijne van ’t Riet, Tom M. Karsten, Mark R. de Vries, Laurents P.S. Stassen, Niels W.L. Schep, G. Ben Schmidt, W.H. Hoffman (Reinier de Graaf Gasthuis); Michiel J.M. Segers, Jacco A.C. Zijl, Bart Verhoeven, Anke B. Smits, Jean Paul P.M. de Vries, Bram Fioole, Henk van der Hoeven, Evert B.M. Theunissen, Tammo S. de Vries Reilingh, Lonneke Govaert, Philippe Wittich, Maurits de Brauw, Jan Wille, Peter M.N.Y.M. Go, Ewan D. Ritchie, Ronald N. Wessel, Eric R. Hammacher (St. Antonius Ziekenhuis); Michiel H.J. Verhofstad, Joost Meijer, Teun van Egmond, Frank H.W.M. van der Heijden, Igor van der Brand (St. Elisabeth Ziekenhuis); Harm M van der Vis, Martin Campo, Ronald Verhagen, G.H. Robert Albers, Arthur W. Zurcher (Tergooi Ziekenhuizen); Albert van Kampen, Jan Biert, Arie B. van Vugt, Michael J.R. Edwards, Taco J. Blokhuis, Jan Paul M. Frölke, Leo M.G. Geeraedts, Jean W.M. Gardeniers, Edward T.C.H. Tan, Lodewijk M.S.J. Poelhekke, Maarten C. de Waal Malefijt, Bart Schreurs (University Medical Center St. Radboud); Rogier K.J. Simmermacher, Jeroen van Mulken, Karlijn van Wessem, Taco J. Blokhuis, Steven M. van Gaalen, Luke P.H. Leenen (University Medical Center Utrecht).

International:

Susan Liew, Harvinder Bedi, Ashley Carr, Andrew Chia, Steve Csongvay, Hamish Curry, Stephen Doig, Craig Donohue, Elton Edwards, Greg Etherington, Andrew Gong, Arvind Jain, Doug Li, Russell Miller, Ash Moaveni, Matthias Russ, Lu Ton, Otis Wang, Zoe Murdoch, Claire Sage (The Alfred, Australia); Mahesh Bhatia, Vinod Arora, (RLB Hospital and Research Centre, India); Frede Frihagen, John Clarke-Jenssen, Geir Hjorthaug, Torben Ianssen, Asgeir Amundsen, Jan Egil Brattgjerd, Tor Borch, Berthe Bøe, Bernhard Flatøy, Sondre Hasselund, Knut Jørgen Haug, Kim Hemlock, Tor Magne Hoseth, Geir Jomaas, Thomas Kibsgård, Bjørn Kristiansen, Tarjei Lona, Gilbert Moatshe, Oliver Müller, Marius Molund, Tor Nicolaisen, Fredrik Nilsen, Jonas Rydinge, Morten Smedsrud, Are Stødle, Axel Trommer, Stein Ugland, Elise Berg Vesterhus, Anne Christine Brekke (Ulleval University Hospital, Norway); Ajay Gupta, Niraj Jain (Nirmal Hospital, India); Ateet Sharma, Amir Sanghavi (Satellite Orthopaedic Hospital and Research Centre, India); Kevin Tetsworth, Donald Geoff, Patrick Weinrach, Paul Pincus, Steven Yang, Brett Halliday, Trevor Gervais, Michael Holt, Annette Flynn (Royal Brisbane and Women’s Hospital, Australia); Amal Shankar Prasad, Vimlesh Mishra (Madhuraj Nursing Home, India); Anil Rai, Subash (Highway Hospital, India); D.C. Sundaresh, Angshuman Khanna (M.S. Rammaiah Medical College & Hospital, India); Joe Joseph Cherian, Davy J Olakkengil, Gaurav Sharma (St John’s Medical College Hospital, India); Vineet Yadav, Sanjay Singh, Kamal Rai (Popular Hospital, India); Marinis Pirpiris, David Love, Andrew Bucknill, Richard J Farrugia (Royal Melbourne Hospital, Australia); B. Sachidananda Rai, Janakiraman Rajakumar (Unity Health Complex, India); Hans-Christoph Pape, Matthias Knobe, Roman Pfeifer (University of Aachen Medical Center, Germany); Akhil Dadi, Naveen Palla (Sunshine Hospital, India).

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Mathew, G., Kowalczuk, M., Hetaimish, B. et al. Radiographic prevalence of CAM-type femoroacetabular impingement after open reduction and internal fixation of femoral neck fractures. Knee Surg Sports Traumatol Arthrosc 22, 793–800 (2014). https://doi.org/10.1007/s00167-014-2835-6

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