Closed Reduction Followed by Percutaneous Fixation of Acute Femoral Neck Fractures in Young Adults: A Retrospective Cohort Study

Abstract

OBJECTIVES: To evaluate the surgical outcomes of femoral neck fractures (FNF) in young adults treated with a closed reduction technique because it pertains to reduction quality, rates of union, and risk factors for complication. METHODS: Design: Retrospective cohort study with radiograph and electronic medical record review. Setting: Level 1 Swiss Trauma Center. Patient Selection Criteria: Between 2012 and 2021, young adults with isolated FNF (AO/OTA 31-B1) treated with percutaneous internal fixation were selected. Exclusion criteria were open reduction technique, age older than 65 years or younger than 16 years, pathologic fractures, and associated femoral head or shaft fractures. Outcome Measures and Comparisons: Primary outcome was quality of reduction, as assessed by 3 experienced trauma surgeons' evaluation of intraoperative and/or first postoperative radiographs using the overall impression, the Garden alignment index, and Lowell criteria. In addition, clinical outcomes, conversion to arthroplasty, and complications after closed reduction and fixation of femoral neck fractures were reviewed. RESULTS: A total of 54 patients with a median interquartile range age of 57.5 (48–60) years were included. Among them, 22 (41%) were women and 32 (59%) were men. The closed reduction technique demonstrated satisfactory reduction results in up to 87% of cases. Major complications occurred in 19%, with 17% requiring conversion to total hip arthroplasty. Unacceptable or borderline acceptable reduction quality correlated significantly with the need for later conversion (P = 0.03). CONCLUSIONS: The study supported the use of the closed reduction technique for acute FNF in patients younger than 65 years, achieving satisfactory reduction results in up to 87% of cases with comparable complication rates to treatment of young femoral neck fractures with open reduction. Furthermore, it underscored the significance of the surgeon's overall impression of reduction quality, alongside the established reduction criteria, the Garden alignment index, and Lowell criteria, in evaluating the quality of the reduction. In addition, risk of conversion to total hip arthroplasty was associated with worse closed reduction quality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.