Management Of Femoral Neck Fractures Research Articles

Dual-Mobility Articulations in Femoral Neck Fractures: A Systematic Review of the Literature and Meta-analysis of the Outcomes.

Femoral neck fractures have been traditionally managed with hemiarthroplasty (HA) or conventional total hip arthroplasty (CTHA). There has been recent interest in using dual-mobility components (DMC) in total hip arthroplasty for patients with femoral neck fractures to provide increased stability and decrease the need for future revision. We conducted a systematic review of the literature reporting on the use of DMC in the management of femoral neck fractures in geriatric patients. We included studies in which DMC were used alone and studies that included a comparison to total hip arthroplasty or HA. The outcomes of interest were postoperative dislocation, revision, and revision surgery rates. Two separate subgroup analyses were conducted. For the comparative studies, we analyzed the differences in outcomes using a random-effects model of relative risks. For the noncomparative studies, we estimated the cumulative incidence of the different outcomes. Eighteen studies met the inclusion criteria and were included in our analysis. Eleven noncomparative studies showed a cumulative incidence of dislocation to be 1.2% (95% confidence interval = 0.3% to 2.7%) when DMC were used alone. Subgroup analyses of the seven comparative studies yielded a relative risk of dislocation using DMC was 59% less than HA and 83% less than CTHA. DMC also compared favorably in terms of revision surgery and revision rates to HA. There was insufficient quality evidence to comment on revision surgery and revision rates when compared with CTHA in comparative studies, but among the noncomparative studies, there was a low rate of revision and revision surgery. Our study revealed overall lower risk of dislocation using DMC compared with both CTHA and HA. There were also lower revision and revision surgery rates when DMC were used compared with HA. Further studies are required to elucidate cost-effectiveness and long-term outcomes of DMC in these scenarios. Level III-meta-analysis.

Cemented versus cementless bipolar hemiarthroplasty for femoral neck fractures in the elderly.

The management of femoral neck fractures remains controversial. Treatment options include a wide variety of internal fixation methods, unipolar or bipolar hemiarthroplasty or total hip replacement.We carried out a systematic review of the available literature to detect differences between cemented and cementless fixation of bipolar prostheses in treating femoral neck fractures in patients aged 60 years or older.Thirteen studies involving a total of 1561 bipolar hemiarthroplasties (770 cemented and 791 uncemented) were identified. Uncemented hemiarthroplasty was associated with significantly lower blood loss (p < 0.0001), shorter operative time (p < 0.0001), less infection (p = 0.03) and lower risk of heterotopic ossification (p = 0.007). On the other hand, patients with cemented hemiarthroplasty suffered significantly less postoperative thigh pain than those with cementless implantation (p < 0.00001).The existing evidence indicates that uncemented bipolar hemiarthroplasty offers shorter operative time, less blood loss, lower local complications and a similar rate of systemic complications and reoperations as compared to cemented implantation.Cite this article: EFORT Open Rev 2021;6:380-386. DOI: 10.1302/2058-5241.6.200057

¿Es necesaria la incidencia radiográfica de perfil para clasificar las fracturas mediales de cadera? Análisis intra e inter observador utilizando la clasificación de Garden

INTRODUCCIÓN: Históricamente, el diagnóstico de una fractura medial de cadera requiere de una radiografía anteroposterior (AP) y de perfil (P). Nos propusimos analizar la importancia de la radiografía de perfil en la evaluación y planificación del tratamiento de las fracturas mediales de cadera, utilizando la clasificación de Garden.&#x0D; MATERIALES Y MÉTODOS: Se prepararon diapositivas con radiografías AP y de P de 100 pacientes con fracturas mediales de cadera admitidos en nuestra central de emergencias. Tres cirujanos de cadera evaluaron de forma independiente las incidencias AP únicamente y luego las vistas AP y P, utilizando la clasificación de Garden. &#x0D; RESULTADOS: Se utilizó el método de Kruskal Wallis para comparar los rangos en la clasificación de Garden después de ver la proyección de P y no se encontraron diferencias estadísticamente significativas (Kruskal Wallis 0, p=1). El acuerdo ponderado entre AP y el AP combinado con el P del Garden promedio fue de 81 % (p &lt; 0.001). Se analizó el porcentaje de pacientes recategorizados entre fracturas no desplazadas y desplazadas, tras observar el perfil: 5% (n=5, IC 95% 1-11%) . Para comparar el Garden AP con el Garden P, se utilizó el método kappa ponderado cuadrático.&#x0D; CONCLUSIONES: Existe una alta concordancia en la clasificación de Garden al comparar las observaciones de las radiografías AP, con las observaciones AP y P juntas. Cinco pacientes hubiesen recibido un tratamiento quirúrgico diferente dependiendo del especialista que interpretaba las radiografías. Esto permite destacar la importancia de solicitar la incidencia de perfil de rutina en pacientes con sospecha de fractura medial de cadera.&#x0D; palabras clave: cadera; fracturas de cadera; prótesis de cadera; lesiones de la cadera; radiografía

A comprehensive program for enhanced management of femoral neck fractures including an enhanced recovery after surgery program: A retrospective study.

To retrospectively analyze the functional outcomes and complications in patients who underwent hip arthroplasty with enhanced recovery after surgery (ERAS) program for femoral neck fractures.Between June 2015 and May 2019, 1138 patients with femoral neck fractures were treated in our department. According to the Garden classification system, 467 cases were type III and 671 cases were type IV with an average age of 74.9 ± 8.8 years (range, 59–96 years). All patients underwent hip arthroplasty with ERAS. The clinical outcomes of these patients were retrospectively analyzed at the final follow-up using the Harris hip score (HHS).The median follow-up was 21.2 months (range, 6–36 months). The mean time to surgery and the length of hospitalization after surgery were 2.4 and 2.2 days, respectively. Eight hundred and fifty-two patients (74.9%) were operated within 48 hours from admission, 1052 cases (92.4%) were discharged within 48 hours after surgery. Twelve patients (1.05%) were readmitted for prosthetic dislocation. None of the patients suffered from infection, periprosthetic fractures, and/or prosthetic loosening. The HHS at the final follow-up was 92.7 ± 7.6, with an excellent or good rate of 90.2%.Patient-oriented ERAS optimizes the interventional measures during the perioperative period for geriatric patients with femoral neck fractures and can improve their short-term clinical outcomes without increased readmission rates.

The management of displaced femoral neck fractures: a narrative review.

This article serves to review the existing clinical guidelines, and highlight the most recent medical and surgical recommendations, for the management of displaced femoral neck fractures (FNFs). It stresses the need for multi-disciplinary intervention to potentially improve mortality rates, limit adverse events and prevent further economic liability.Globally, the incidence of FNFs continues to rise as the general population ages and becomes more active. The annual number of FNFs is expected to exceed six million by 2050. The increased burden of FNFs exacerbates the demand on all services associated with treating these injuries.The management of FNFs may serve as an indicator of the quality of care of the geriatric population. However, despite escalating health costs, a significant 30-day and one-year mortality rate, increased rate of peri-operative adverse events and sub-optimal functional clinical outcomes, continued controversy exists over optimal patient care.Much debate exists over the type of surgery, implant selection and peri-operative clinical care and rehabilitation. FNF care models, systematized clinical pathways, formal geriatrics consultation and specialized wards within an established interdisciplinary care framework may improve outcomes, mitigate adverse events and limit unnecessary costs.Cite this article: EFORT Open Rev 2021;6:139-144. DOI: 10.1302/2058-5241.6.200036

Cemented versus uncemented hemiarthroplasty for the management of femoral neck fractures in the elderly: a meta-analysis and systematic review.

Hemiarthroplasty is commonly used to treat unstable femoral neck fractures in older patients. However, there is no consensus on the use of cement during hemiarthroplasty. Therefore, we performed a systematic review to focus on the outcomes of cemented and uncemented hemiarthroplasty for the treatment of femoral neck fractures in older patients. Pubmed, Cochrane Central Register of Controlled Trials, and Ovid were searched for studies related comparison of cemented versus uncemented hemiarthroplasty for unstable femoral neck fractures from inception to Jan 20, 2020. The quality of the included randomized controlled trials (RCTs) was assessed using the Cochrane Collaboration tool. The meta-analysis was performed using the RevMan 5.2 software. Eleven RCTs were included in the meta-analysis. Cemented hemiarthroplasty was found to be superior to uncemented arthroplasty with respect to reoperation rate (RR 0.6, 95% CI 0.38-0.96, p = 0.03), complications related to prosthesis (RR 0.39, 95% CI 0.23-0.68, p = 0.0008), residual pain (RR 0.66, 95% CI 0.52-0.83, p = 0.0004), and operation time (MD 8.22, 95% CI 6.30-10.14, p < 0.00001). There were no significant between-group differences with respect to local and general complications, duration of hospital stay, hip function, and mortality. This meta-analysis showed cemented hemiarthroplasty might be an optimum choice for treating unstable femoral neck fractures in older patients. However, the results of this meta-analysis should be interpreted cautiously owing to some limitations. Further studies are required to provide more robust evidence.

The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital.

Background: Femoral neck fractures (FNFs) remain “the unsolved fracture” and optimal management is still controversial. The outcomes of hemiarthroplasty (HA) and total hip arthroplasty (THA) in the treatment of FNFs are inconsistent. As demand for management of FNFs continues to grow globally, evaluation of the appropriateness of treatment remains essential, particularly in resource-constrained settings. Methods: We conducted a retrospective chart review of all patients presenting with isolated low energy intracapsular FNFs to an orthopaedic academic unit in Sub-Saharan Africa from January 2016 to April 2019. The decision regarding HA or THA was largely based upon the Sernbo score and ASA classification. The majority of patients with a Sernbo score of ≥15 and ASA class III or better received THA. Results: There were 117 patients (33 male/84 female) 72 years (33–97 years) with FNFs who underwent 56 THA and 61 HA between January 2016 and April 2019. The mean Sernbo score was 15.99 overall (range 8–20) and was 18.95 (11–20) for THA patients compared to 14.46 (8–20) for HA patients (p = 0.042). Time taken from admission to the theatre was 8–19 days (1–22) and 7–61 days (2–31) for HA and THA respectively. The average length of stay (LOS) was 16.04 days and the main reason for same-day cancellations was the lack of post ICU/High Care beds. The 30-day mortality rates were 1.78% and 4.91% for THA and HA patients, respectively (p = 0.07). The mortality rate for patients with a Sernbo score < 15 was 15.38% overall, 8.93% for THA patients, and 21.31% for HA patients, respectively (p = 0.021). Conclusion: The 30-day mortality rate was comparable with published rates from developed countries. There were significant delays in time to theatre, high rates of same-day surgical cancellations, and increased LOS for both HA and THA. These factors play a cumulative role in inflating costs on a strained healthcare system in a developing country. A multidisciplinary approach including the care provision of a specialized geriatric unit is recommended.Retrospective Study, Level III evidence

Hip hemiarthroplasty with modular neck: is it useful in residents' learning curve? A prospective clinical trial.

The number of femoral neck fractures (FNFs) worldwide will drastically increase in the next few decades, reaching 6.3 million by 2050. In the future, therefore, newly-qualified orthopaedic surgeons will treat this kind of injury more frequently than in past decades. This prospective observational study aims to assess whether hip hemiarthroplasty with modular neck, performed via the Hardinge approach, can be safely carried out by orthopaedic residents. Patients referred to our Level I trauma centre, between January 2016 and June 2017, with displaced intra-articular femoral fractures, were prospectively recruited. All patients underwent cemented modular bipolar hip hemiarthroplasty (Profemur Z, MicroPort Orthopedics Inc., Arlington, TN, USA) via the Hardinge approach, with the patient positioned in lateral decubitus. The surgical procedures were performed by the same surgical and anesthesiology team, under spinal anaesthesia. All patients underwent clinical and radiographic follow-up up to 24 months. Complications and re-operations were recorded. Clinical evaluation was performed using the Harris Hip Score (HHS), Osteoporosis Quality of Life Questionnaire QUALEFFO-41 and EuroQol-5D (EQ-5D) questionnaire. Anteroposterior pelvis x-rays were performed preoperatively, postoperatively and at 1, 3, 6, 12 and 24 months follow-up. 118 patients met the inclusion criteria (male: 50; female: 68; mean age: 74.3 years; range 65-88 years) and were included in the current study. 67 patients out of 118 (56.8%) were managed by senior orthopaedic surgeons (Group A), whereas the remaining 51 patients out of 118 (43.2%) were treated by orthopaedic residents (Group B). Hip hemiarthroplasties performed by senior surgeons showed the prevalent use of straight (short or long) necks, whereas, in surgical procedures performed by residents, there was a significantly higher use of varus/valgus, anteverted or retroverted necks. The overall complication rate was significantly higher in Group-B patients, compared with Group-A patients (p = 0.002). The length of hospital stay and the mean clinical scores at 24 months follow-up showed no significant differences. Hip hemiarthroplasty with modular neck can be safely employed during the learning curve of orthopaedic residents. Great efforts, however, should be made in future to improve residents' training in the management of FNFs.

Factors Associated With Mortality After Surgical Management of Femoral Neck Fractures.

Hip fractures are recognized as one of the most devastating injuries impacting older adults because of the complications that follow. Mortality rates postsurgery can range from 14% to 58% within one year of fracture. We aimed to identify factors associated with increased risk of mortality within 24 months of a femoral neck fracture in patients aged ≥50 years enrolled in the FAITH and HEALTH trials. Two multivariable Cox proportional hazards regressions were used to investigate potential prognostic factors that may be associated with mortality within 90 days and 24 months of hip fracture. Ninety-one (4.1%) and 304 (13.5%) of 2247 participants died within 90 days and 24 months of suffering a femoral neck fracture, respectively. Older age (P < 0.001), lower body mass index (P = 0.002), American Society of Anesthesiologists (ASA) class III/IV/V (P = 0.004), use of an ambulatory aid before femoral neck fracture (P < 0.001), and kidney disease (P < 0.001) were associated with a higher risk of mortality within 24 months of femoral neck fracture. Older age (P = 0.03), lower body mass index (P = 0.02), use of an ambulatory aid before femoral neck fracture (P < 0.001), and having a comorbidity (P = 0.04) were associated with a higher risk of mortality within 90 days of femoral neck fracture. Our analysis found that factors that are indicative of a poorer health status were associated with a higher risk of mortality within 24 months of femoral neck fracture. We did not find a difference in treatment methods (internal fixation vs. joint arthroplasty) on the risk of mortality. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Is Total Hip Arthroplasty a Cost-Effective Option for Management of Displaced Femoral Neck Fractures? A Trial-Based Analysis of the HEALTH Study

Displaced femoral neck fractures are a significant source of morbidity and mortality and can be treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA). Proponents of THA have argued THA offers lower risk of revision, with improved functional outcomes when compared to HA. To evaluate cost effectiveness of THA compared with HA, a trial-based economic analysis of the HEALTH study was undertaken. Health care resource utilization (HRU) and health-related quality of life (HRQoL) data were collected postoperatively and costed using publicly available databases. Using EuroQol-5 Dimensions (EQ-5D) scores, we derived quality adjusted life years (QALYs). A 1.5% discount rate to both costs and QALYs was applied. Age analyses per age group were conducted. All costs are reported in 2019 Canadian dollars. When compared with HA, THA was not cost-effective for all patients with displaced femoral neck fractures ($150,000/QALY gained). If decision makers were willing to spend $50,000 or $100,000 to gain one QALY, the probability of THA being cost-effective was 12.8% and 32.8%, respectively. In a subgroup of patients younger than 73 (first quartile), THA was both more effective and less costly. Otherwise, THA was more expensive and yielded marginal HRQoL gains. Our results suggest that for most patients, THA is not a cost-effective treatment for displaced femoral neck fracture management versus HA. However, THA may be cost effective for younger patients. These patients experience more meaningful improvements in quality of life with less associated cost because of shorter hospital stay and fewer postoperative complications. Economic Level II. See Instructions for Authors for a complete description of levels of evidence.

A PROSPECTIVE STUDY OF COMPLICATIONS IN BIPOLAR HEMIARTHROPLASTY USING MODIFIED HARDINGE APPROACH IN THE MANAGEMENT OF FEMORAL NECK FRACTURES

Introduction: Fracture of femoral neck is on the rise in the recent years owing to the increase in the geriatric population, severe osteoporosis and increased brittleness of the bone with advancing age. Total hip replacement was mostly used in the initial days but owing to higher chances of dislocations, it is less preferred. Bipolar hemiarthroplasty has become one of the main methods of treatment. A variety of surgical approaches have been used. Posterior approach is the most preferred approach currently, followed by Hardinge approach. Complications like dislocation, infection and abductor lurch are still common with current approaches. This study was undertaken to show the functional outcomes of a Modified Hardinge approach which seems to have optimal results out of all the approaches.&#x0D; Aim: To evaluate the functional outcomes and complications of modified hardinge approach.&#x0D; Materials and Methods: A total of 20 patients with fracture neck of femur were taken into the study and treated with Bipolar Hemiarthroplasty using modified Hardinge approach between June 2018 and October 2019. Each patient was put through the same preoperative and postoperative protocols. They was screened for comorbidities and were taken up for surgery. Complications after this approach were evaluated post operatively for a period of 6 months.&#x0D; Results: The mean hip score was 80. Complications like posterior hip dislocation and infection were nil. Abductor lurch was not noted in any of the patients. One patient had infection out of 20 which was managed accordingly.&#x0D; Conclusion: Bipolar hemiarthroplasty through modified Hardinge approach can be used in the management of femoral neck fractures with lowest complication rate. Complications like posterior dislocation and abductor lurch were nil in the study. The only downside of the procedure being a longer learning curve makes it a less used approach compared to others.&#x0D; Keywords: Hemiarthroplasty, modified Hardinge approach, femoral neck fracture

Management of Femoral Neck Fracture Treated with Dynamic Hip Screw and Bone Grafting

Fracture of neck of femur is most common injury in adults. In old age it occurs as a low energy trauma while in young individuals it is due to high energy..

Fixation of femoral neck fractures in patients younger than 65 years: a retrospective descriptive study at a high-volume trauma centre

ABSTRACT BACKGROUND: The management of femoral neck fractures in the younger patient remains contentious, with high failure rates being reported in the literature. Patient age usually plays a major role during decision-making with regard to head-sparing versus head-sacrificing surgical strategies. The aim of this study was to review the outcomes of fixation of femoral neck fractures in patients younger than 65 years in an attempt to identify factors that might predict fixation failure. METHODS: A retrospective study, evaluating the outcome of fixation of femoral neck fractures in patients younger than 65 years of age was conducted. Factors affecting the outcome of treatment were explored in an attempt to identify variables that might predict fixation failure. RESULTS: The final cohort comprised 51 men (76%) and 16 women (24%) with a mean age of 43.9±12.2 years (95% CI 41.0-46.8; range 23-64) and a median follow-up of 8.7 months (IQR 6.2-17.4). Thirteen patients (19%) presented with undisplaced (Garden I and II) fractures while 54 (81%) presented with displaced (Garden III and IV) fractures. Twenty-four patients (36%) met the definition of failure. These included 15 cases (22%) of non-union, seven cases (10%) of femoral neck collapse and two cases (3%) of avascular necrosis. Sixteen patients (24%) underwent conversion to total hip arthroplasty. All cases of failure occurred in patients who presented with Garden III and IV displaced fractures. Factors associated with failure included the presence of fracture comminution (p&lt;0.001) and the increased vertical orientation of the fracture line according to the Pauwels classification (p&lt;0.001). Neither patient age (p=0.117), time from injury to surgery (p=0.204), mechanism of injury (p=0.136), smoking (p&gt;0.999) nor alcohol abuse (p=0.528) was associated with failure CONCLUSION: The incidence of fixation failure following surgical management of femoral neck fractures in patients younger than 65 years of age remains high. While undisplaced fractures heal readily regardless of time from injury to surgery, mechanism of injury or fixation method, displaced fractures remain a difficult problem to solve. In our series, fixation failure was observed in one in three patients, while one in four required revision to total hip arthroplasty. Level of evidence: Level 4. Keywords: femoral neck fracture, fixation, failure, non-union, avascular necrosis

Femoral Neck Fractures in Children: Issues, Challenges, and Solutions.

Femoral neck fractures in children are rare injuries resulting from high-energy trauma. Different methods of treatment, lack of standard management protocols, and the high risk of complications make this injury one of the biggest challenges that an orthopaedic surgeon can face. This review focuses on the general aspects of the pediatric femoral neck fracture management as well as its complications and possible solutions.

Results of treatment of fractures of the femoral neck in adults by intermediate hip Monoblock Prosthesis: About 125 cases

Introduction: Fractures of the upper extremity of the femur (EFSF) occur by far, most frequently in the elderly and are the most serious because of their morbidity, mortality and their economic impact. Partial joint arthroplasty (PIH) is a solution of choice for the management of femoral neck fractures. The objective of our study was to analyze the therapeutic results after monobloc hip joint arthroplasty. Material and Methods: This ag it a bi-center retrospective study from January 2014 to June 2017. A total of 125 cases were identified in 73 women and 52 men with a mean age of 68 years +/- 10,12. The average time between the first consultation and the surgery was 12,30 days (extreme: 2- 548 days). The etiologies were dominated by falls (72,2%). The study parameters were the therapeutic data (recent fracture or nonunion, type of anesthesia, approach, type of implant, possible intraoperative complications) and postoperative anatomo-radiological data (stem orientation, femoral offset, ILMI, seal quality, possible complications and functional assessment according to the PMA score). Results: There were 96 recent fractures and 29 nonunions. The approach was transgluteal (86 patients) and postero-external (39 patients). Prosthesis sizes 46 and 48 were the most used. Cemented stems represented 87, 2% of cases. In intraoperative 5 trochanteric cracks, 1 acetabular fracture and one wrong were noted. A node earner decrease (mean 16.3 months for extremes of 6 and 42 months), 76% of the stems were medialized against 9% lateralized. The femoral offset was restored in 32%, increased in 36% and decreased in 32% of cases. The lower limbs were iso-equal in 37.6% of cases and an ILMI equal +/- 1cm in 62.4% of patients. Sealing was good in 89%. We observed 20.8% of cases of lameness, 4% of cases of early dislocation, 3.2% of cases of loosening. According to the PMA rating, our results were satisfactory in 74.4% and bad in 7.2%. Conclusion: In view of our results, PIH ensures, in the short and medium term, satisfactory functional results. A mastery of the technique and a rigor in its realization must make it possible to ensure a satisfactory survival of the implant.

The relationship between femoral neck fracture in adult and avascular necrosis and nonunion: A retrospective study.

BackgroundOne of the most serious sequelae of femoral neck fractures (FNFs) is avascular necrosis (AVN), and this complication translates to significant morbidity and mortality. This study was conducted to determine the relationship between the etiologies and management of FNFs at our institution and the development of AVN or nonunion.Materials and methodsThis study was a retrospective medical chart review of all adult patients admitted and managed for FNF.ResultsThere were a total of 69 FNF patients reviewed. FNF was caused by a fall in 37 patients (53.6%), a road traffic accident in 16 (23.2%), motorcycle and motorbike accidents in 8 (11.6%), and heavy exercise in 8 (11.6%). Twenty-four patients (34.8%) had fixation within 24 h of injury, and 45 (65.2%) went more than 24 h before fixation. The mean RUSH score at 6 months was 21.4 ± 5.1. There were 4 patients (5.8%) with a collapsed FNF and 4 patients (5.8%) had a nonunion FNF. AVN was documented in 12 patients (17.4%). Of the 12 patients who had AVN, 8 (66.7%) received fixation within 24 h from the time of the injury, whereas only 4 (33.3%) received fixation more than 24 h after the injury. There was a significant negative correlation between the time of fixation and AVN.ConclusionWe report a 17.4% incidence of AVN over 10 years in patients managed with FNF. AVN was found to be significantly correlated with the mode of injury (fall and RTA among younger male patients).

Loss of Independence After Operative Management of Femoral Neck Fractures.

The FAITH trial evaluated effects of sliding hip screws versus cancellous screws in femoral neck fracture patients. Using FAITH trial data, we quantified changes in living status, use of aids, and investigated factors associated with living and walking independently 12 months after fracture. We conducted a descriptive analysis to quantify patients' changes in living status, use of aids, and used multivariable Cox regression analyses to determine factors associated with living and walking independently after fracture. Of patients who lived independently before hip fracture, 3.07% (50-80 years old) and 19.81% (>80 years old) were institutionalized 12 months after injury. Of patients who were walking independently before injury, 33.62% (50-80 years old) and 69.34% (>80 years old) required a walking aid 12 months after injury. Factors associated with higher chances of living independently included the following: being between 50 and 80 years, having a class I American Society of Anesthesiologists classification, not using a walking aid before fracture, being a nonsmoker or former smoker, and having an acceptable quality of implant placement. Factors associated with higher chances of walking without an aid included the following: being between 50 and 80 years, having a class I American Society of Anesthesiologists classification, living independently before fracture, being a nonsmoker or former smoker, having an undisplaced fracture, and not requiring revision surgery. Femoral neck fracture patients suffer great losses of independence. Identifying factors associated with living and walking independently after hip fracture may help surgeons better identify which patients are at risk and optimize care of patients with this injury. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Trends in Utilization of Total Hip Arthroplasty for Femoral Neck Fractures in the United States.

The ideal mode of fixation for patients with femoral neck fractures is not well defined in the current literature. This study describes the recent trends in surgical management of femoral neck fractures with an analysis on perioperative outcomes. The National Hospital Discharge Survey was used to identify femoral neck fractures in the United States between 1990 and 2007 (n = 1,155,960) treated with open reduction and internal fixation (ORIF), total hip arthroplasty (THA), or hemiarthroplasty (HA). Trends were examined over the following 3 time periods: 1990 to 1995 (group 1), 1996 to 2001 (group 2), and 2002 to 2007 (group 3). Elixhauser Comorbidity Index and perioperative complications were calculated. Use of HA increased (74.4% to 84.6%), whereas that of THA (7.3% to 4.9%) and ORIF (18.3% to 10.6%) decreased, from group 1 to group 3 in the age group of >80 years. The use of ORIF increased (63.9% to 81.4%), whereas the use of both HA and THA decreased, from group 1 to group 3 in the age group of <50 years. The rate of adverse events increased across all fixation types but was greatest among THA (32.2% to 48.3%). The femoral neck patient population is now older and has more medical comorbidities. We observed a trend toward performing HA in older patients and ORIF in younger patients. Despite superior functional outcomes reported in THA, this study found a decreased utilization of THA in all age groups along with an increase in adverse events and nonroutine discharges for patients with femoral neck fractures treated with THA.

Methods of fixation used in management of femoral neck fractures in adults: a systematic review

Background: Femoral neck fractures in adults younger than 50 yr old are uncommon and often result from high-energy trauma. They account for only 2-3% of all femoral neck fractures. Femoral neck fractures in young adults are associated with a high incidence of femoral head osteonecrosis and nonunion. Dynamic hip screw, multiple cannulated screws, and a Targon® femoral neck (TFN) plate can be used in management. A systematic review of the literature was done to evaluate which technique is best. Methods: After literature search, 11 articles were found and were reviewed to evaluate final outcome of fixation of femoral neck fractures using dynamic hip screw, multiple cannulated screws, or a TFN plate. Results: After evaluation of all studies, the incidence of nonunion, osteonecrosis of the femoral head, implant failure, and reoperation were almost equal in both dynamic hip screw and TFN plate groups, while it was much higher in the patient group fixed with multiple cannulated screws. Conclusions: Dynamic hip screw fixation had a low incidence of complications in the final outcome when compared with multiple cannulated screws. Further study was needed for application of the TFN plate.

Factors associated with health-related quality of life, hip function, and health utility after operative management of femoral neck fractures.

The primary aim of this prognostic study was to identify baseline factors associated with physical health-related quality of life (HRQL) in patients after a femoral neck fracture. The secondary aims were to identify baseline factors associated with mental HRQL, hip function, and health utility. Patients who were enrolled in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial completed the 12-item Short Form Health Survey (SF-12), Western Ontario and McMaster Universities Arthritis Index, and EuroQol 5-Dimension at regular intervals for 24 months. We conducted multilevel mixed models to identify factors potentially associated with HRQL. The following were associated with lower physical HRQL: older age (-1.42 for every ten-year increase, 95% confidence interval (CI) -2.17 to -0.67, p < 0.001); female gender (-1.52, 95% CI -3.00 to -0.05, p = 0.04); higher body mass index (-0.69 for every five-point increase, 95% CI -1.36 to -0.02, p = 0.04); American Society of Anesthesiologists class III ( versus class I) (-3.19, 95% CI -5.73 to -0.66, p = 0.01); and sustaining a displaced fracture (-2.18, 95% CI -3.88 to -0.49, p = 0.01). Additional factors were associated with mental HRQL, hip function, and health utility. We identified several baseline factors associated with lower HRQL, hip function, and utility after a femoral neck fracture. These findings may be used by clinicians to inform treatment and outcomes. Cite this article: Bone Joint J 2018;100-B:361-9.