Anterior positioning screw in proximal femoral plating restr
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This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt.

Researchers retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt.

Results:
--Age, gender, Garden classification, posterior comminution, and reduction quality showed no significant difference between the groups.

--Increased posterior tilt was lower in the ALTS group (3.2°) than that in the NTS group (5.3°), and the percentage of people with more than 5° of posterior tilt was also lower in the ALTS group (5).

--Femoral neck shortening (FNS) was lower in the ALTS group (3.1 mm vs. 4.3 mm), though not statistically significant when using 5 mm as the cut-off value.

--Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0 vs. 82.0).

--Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups.

--Multivariable analysis identified posterior comminution (OR 15.9), suboptimal reduction quality (OR 12.0), and NTS configuration (OR 21.9) as risk factors for developing posterior tilt.

Finally, in the fixation of retroverted femoral neck fractures, the configuration of anterior positioning screws in proximal femoral plating provides greater resistance to posterior tilt. Also at risk for developing posterior tilt are posterior comminution, suboptimal reduction, and NTS configuration.

Source: https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02456-9
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