This is a preplanned secondary analysis of the FAITH trial asking whether posterior tilt predicts failure after fixation of Garden-I and II femoral neck fractures in older patients. It tests whether a tilt threshold on the preoperative lateral radiograph should push the surgeon toward primary arthroplasty instead of internal fixation.
When you see a non-displaced femoral neck fracture in an elderly patient, get a good shoot-through lateral and measure posterior tilt before defaulting to screws. Tilt ≥20° roughly doubles the chance the patient comes back for arthroplasty, so in an older patient this is the moment to consider primary arthroplasty and spare them a second operation.
The risk factors are additive. A woman ≥80 with tilt ≥20° failed fixation nearly half the time, which is a strong argument against fixing that particular fracture.
Weight this appropriately: it is a Level IV prognostic secondary analysis, so it shows association, not causation, and could not adjust for osteoporosis. The prior literature is mixed, with most studies (Palm, Dolatowski, Clement) supporting a tilt threshold and one (Lapidus) finding no effect.
A strength worth knowing for boards: this is the analysis that extended the tilt finding to sliding hip screw fixation, not just cannulated screws.
This is a preplanned secondary analysis of the FAITH trial asking whether posterior tilt predicts failure after fixation of Garden-I and II femoral neck fractures in older patients. It tests whether a tilt threshold on the preoperative lateral radiograph should push the surgeon toward primary arthroplasty instead of internal fixation.
When you see a non-displaced femoral neck fracture in an elderly patient, get a good shoot-through lateral and measure posterior tilt before defaulting to screws. Tilt ≥20° roughly doubles the chance the patient comes back for arthroplasty, so in an older patient this is the moment to consider primary arthroplasty and spare them a second operation.
The risk factors are additive. A woman ≥80 with tilt ≥20° failed fixation nearly half the time, which is a strong argument against fixing that particular fracture.
Weight this appropriately: it is a Level IV prognostic secondary analysis, so it shows association, not causation, and could not adjust for osteoporosis. The prior literature is mixed, with most studies (Palm, Dolatowski, Clement) supporting a tilt threshold and one (Lapidus) finding no effect.
A strength worth knowing for boards: this is the analysis that extended the tilt finding to sliding hip screw fixation, not just cannulated screws.