Treatment Failure in Femoral Neck Fractures in Adults Less Than 50 Years of Age: Analysis of 492 Patients Repaired at 26 North American Trauma Centers

Abstract

Objectives:To assess the operative results of femoral neck fractures (FNFs) in young adults in a large multicenter series, specifically focusing on risk factors for treatment failure.Design:Large multicenter retrospective cohort series.Setting:Twenty-six North American Level 1 trauma centers.Patients:Skeletally mature patients younger than 50 years with displaced and nondisplaced FNFs treated between 2005 and 2017.Intervention:Operative repair of FNF.Main outcome measurements:The main outcome measure is treatment failure: nonunion and/or failed fixation, osteonecrosis, malunion, and need for subsequent major reconstructive surgery (arthroplasty or proximal femoral osteotomy). Logistic regression models were conducted to examine factors associated with treatment failure.Results:Of 492 patients with FNFs studied, a major complication and/or subsequent major reconstructive surgery occurred in 45% (52% of 377 displaced fractures and 21% of 115 nondisplaced fractures). Overall, 23% of patients had nonunion/failure of fixation, 12% osteonecrosis type 2b or worse, 15% malunion (>10 mm), and 32% required major reconstructive surgery. Odds of failure were increased with fair-to-poor reduction [odds ratio (OR) = 5.29, 95% confidence interval (CI) = 2.41–13.31], chronic alcohol misuse (OR = 3.08, 95% CI = 1.59–6.38), comminution (OR = 2.63, 95% CI = 1.69–4.13), multiple screw constructs (vs. fixed-angle devices, OR = 1.95, 95% CI = 1.30–2.95), metabolic bone disease (OR = 1.77, 95% CI = 1.17–2.67), and increasing age (OR = 1.03, 95% CI = 1.01–1.06). Women (OR = 0.57, 95% CI = 0.37–0.88), Pauwels angle ≤50 degrees (type 1 or 2; OR = 0.64, 95% CI = 0.41–0.98), or associated femoral shaft fracture (OR = 0.19, 95% CI = 0.10–0.33) had lower odds of failure.Conclusions:FNFs in adults <50 years old remain a difficult clinical and surgical problem, with 45% of patients experiencing major complications and 32% undergoing subsequent major reconstructive surgery. Risk factors for complications after treatment of displaced FNFs were numerous.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effects of Technical Errors on the Outcomes of Operatively Managed Femoral Neck Fractures in Adults Less than 50 Years of Age

“…Treatment failures were defined as : 9 Nonunion and/or failed fixation was defined as a lack of healing at >6 months and/or loss of implant integrity and reduction. 9 Osteonecrosis was defined and stratified by the Ficat system.…”

Complex Orthopaedic Trauma Is Shifting Away From Level I to Non–Level I Trauma Centers: An Analysis of the National Trauma Data Bank

“…A cutoff of 50 years of age was selected to conform to similar studies, which used 50 years as the distinction between younger and older patients. 11 Combining both the diagnostic and procedure codes reduced the chance for misclassification. In 2007 to 2015, the principal procedure codes applied were ORIF and CRIF.…”

Letter to the editor on: Treatment Failure in Femoral Neck Fractures in Adults Younger than 50 Years: Analysis of 492 Patients Treated at 26 North American Trauma Centers

“…We would like to congratulate Dr Collinge and colleagues 1 on their recent work describing the outcomes of 492 patients younger than 50 years with femoral neck fractures treated with internal fixation. The Young Femoral Neck Working Group report that nearly half of femoral neck fracture repairs were complicated by major adverse events and one-third required reoperation.…”