Suboptimal outcomes after closed reduction and internal fixation of displaced femoral neck fractures in middle-aged patients: is internal fixation adequate in this age group?

Abstract

BackgroundThere have been many studies regarding nongeriatric femoral neck fractures (FNFs), which included patients of a wide age range (between 20 and 60 years old). We aimed to determine whether internal fixation provided acceptable outcomes for middle-aged patients with displaced FNFs, and identify predictors of successful internal fixation.MethodsA total of 117 patients, aged 50–60 years and who underwent closed reduction and unilateral internal fixation using cannulated screws, were included. The outcomes were classified as either “complications” (varus malunion, femoral neck shortening, non-union/early collapse, avascular necrosis, or arthroplasty during the follow-up) or “optimal outcomes” (no complications). Patients with displaced FNFs (Garden stages III–IV, n = 69) were categorized according to whether they experienced acceptable or unacceptable reduction. We evaluated whether patients’ clinical characteristics could predict optimal outcomes.ResultsPatients with displaced FNFs generally experienced complications (84.1%). Twenty-two percent of patients experienced optimal outcomes when acceptable reduction was achieved. Patients with unacceptable reductions experienced complications. Optimal outcomes were positively associated with Pauwels’ type II fracture (OR: 8.67, p = 0.025) and negatively associated with excessive alcohol consumption (p = 0.045).ConclusionsCompared with the younger age group, complication rates are higher in middle-aged patients with displaced FNFs treated using cannulated screws. If internal fixation is to be used for a displaced FNF, patient selection is essential. Care must be taken to avoid selecting patients with excessive alcohol consumption, while successful internal fixation may be more likely for patients with Pauwels’ type II fracture.

Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture:a systematic review and meta-analysis

“…Data on Garden classification were available for the systematic analysis from 14 studies [16–20, 22–24, 26–30, 32]. The fixed effect model was chosen due to nonsignificant heterogeneity in intra-study comparisons ( I 2 = 1%, P = 0.44).…”

Suboptimal outcomes after internal fixation for displaced intracapsular femoral neck fractures in 50- to 60-year-old patients

“…A study reported 47.8% failure rate in 50-to 60-year-old patients. 6 Another study reported higher failure rate in 40-60 years old group compared to < 40 years group. 10 Relative osteopenia in this group was concerned.…”

“…In younger patients, the primary treatment for a displaced FNF is internal fixation, which includes multiple cannulated screws fixation, sliding hip screws, and muscle-pedicle bone grafting (MPBG) augmented fixation. [1][2][3][4][5][6] In contrast, hemiarthroplasty or total hip arthroplasty (THA) is the standard treatment for patients >60 years old with a displaced FNF. 1,[7][8][9] However, there is a risk of loss of reduction, non-union, and osteonecrosis of the femoral head (ONFH) in osteosynthesis of a displaced FNF.…”

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

“…The age at which patients cease to be "young" is usually suggested to be 60-70 years, but is still debated. One study from the Norwegian Hip Fracture Register (NHFR) reported a high failure rate of 27% after internal fixation for displaced FNFs in patients aged 55-70 (56), and one recent study from Taiwan reported 84.1% complications in displaced FNFs in patients aged [50][51][52][53][54][55][56][57][58][59][60] years (57), suggesting that more patients should receive an arthroplasty.…”