Abstract
PurposeTo determine whether internal fixation (IF) or hip arthroplasty (HA) is associated with superior outcomes in geriatric nondisplaced femoral neck fracture (FNF) patients.MethodsData from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) were analyzed (IF Group 449 and HA Group 1278 patients). In-hospital care and a 120-day postoperative follow-up were conducted. Primary outcomes, including mobility, residential status, reoperation rate, and a generic health status measure (EQ-5D score), and the secondary outcome of mortality were compared between groups. Multivariable analyses were performed to assess independent treatment group associations (odds ratios, ORs) with the primary and secondary end points.ResultsPatients in the HA group were older (83 vs. 81 years, p < 0.001) and scored higher on the Identification of Seniors at Risk screening (3 vs. 2, p < 0.001). We observed no differences in residential status, reoperation rate, EQ-5D score, or mortality between groups. After adjusting for key covariates, including prefracture ambulatory capacity, the mobility of patients in the HA group was more frequently impaired at the 120-day follow-up (OR 2.28, 95% confidence interval = 1.11–4.74).ConclusionTreatment with HA compared to treatment with IF led to a more than twofold increase in the adjusted odds of impaired ambulation at the short-term follow-up, while no significant associations with residential status, reoperation rate, EQ-5D index score, or mortality were observed. Thus, IF for geriatric nondisplaced FNFs was associated with superior mobility 120 days after surgery. However, before definitive treatment recommendations can be made, prospective, randomized, long-term studies must be performed to confirm our findings.
Highlights
Femoral neck fractures (FNFs) are one of the most common injuries (> 50% of all hip fractures) among geriatric trauma patients and are associated with a significant health care burden as well as detrimental effects on quality of life [1,2,3]
Fewer wound infections, less blood loss, and shorter surgery times have been described for the treatment of FNFs with internal fixation (IF) than for hip arthroplasty (HA) [10]
Compared to patients in the IF group (n = 449, 66.0% female), patients in the HA group (n = 1278, 68.2% female) had a higher median age (83 years vs. 81 years, p < 0.001) and higher median ISAR scores (3 vs. 2, p < 0.001) and were less frequently able to ambulate without impairment prior to FNF (36.0% vs. 43.0% p = 0.012)
Summary
Femoral neck fractures (FNFs) are one of the most common injuries (> 50% of all hip fractures) among geriatric trauma patients and are associated with a significant health care burden as well as detrimental effects on quality of life [1,2,3]. During the first year ranging from 8.4% to 36.0% have been observed in hip fracture patients when compared to a prospectively studied population of uninjured individuals [4, 5] Joint replacement techniques, such as total hip replacement (THR) or hemiarthroplasty, are well established as treatments for displaced FNFs [6,7,8]. The risk of nonunion and avascular necrosis of the femoral head (AVN) after osteosynthetic treatment of nondisplaced FNFs has been considered low in the past [11] These findings have been challenged by prospective trials, some of which have yielded beneficial and others unfavorable clinical outcomes of hemiarthroplasty when compared to IF among patients with nondisplaced FNFs [12,13,14]. The present study aimed to compare mobility, residential status, reoperation rate, and health-related quality of life (HRQoL) as well as early mortality associated with IF and HA for nondisplaced FNFs by evaluating data from a geriatric trauma registry
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