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Treatment and Displacement Affect the Reoperation Rate for Femoral Neck Fracture

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A Letter to the Editor to this article was published on 25 September 2013

Abstract

Background

Femoral neck fractures (FNFs) comprise 50% of geriatric hip fractures. Appropriate management requires surgeons to balance potential risks and associated healthcare costs with surgical treatment. Treatment complications can lead to reoperation resulting in increased patient risks and costs. Understanding etiologies of treatment failure and the population at risk may decrease reoperation rates.

Questions/purposes

We therefore (1) determined if treatment modality and/or displacement affected reoperation rates after FNF; and (2) identified factors associated with increased reoperation and timing and reasons for reoperation.

Methods

We reviewed 1411 records of patients older than 60 years treated for FNF with internal fixation or hemiarthroplasty between 1998 and 2009. We extracted patient age, sex, fracture classification, treatment modality and date, occurrence of and reasons for reoperation, comorbid conditions at the time of each surgery, and dates of death or last contact. Minimum followup was 12 months (median, 45 months; range, 12–157 months).

Results

Internal fixation (hazard ratio [HR], 6.38) and displacement (HR, 2.92) were independently associated with increased reoperation rates. The reoperation rate for nondisplaced fractures treated with fixation was 15% and for displaced fractures 38% after fixation and 7% after hemiarthroplasty. Most fractures treated with fixation underwent reoperation within 1 year primarily for nonunion. Most fractures treated with hemiarthroplasty underwent reoperation within 3 months, primarily for infection.

Conclusions

Overall, hemiarthroplasty resulted in fewer reoperations versus internal fixation and displaced fractures underwent reoperation more than nondisplaced. Our data suggest there are fewer reoperations when treating elderly patients with displaced FNFs with hemiarthroplasty than with internal fixation.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank John M. Hamilton BA, and Juhee Song PhD, for data accrual and statistical analysis of our manuscript, respectively.

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Authors and Affiliations

  1. Department of Orthopaedics, Scott & White HealthCare/Texas A&M Health Science Center, 2401 South 31st Street, Temple, TX, 76508, USA

    Donavan K. Murphy MD, MSc, MBA, Timmothy Randell MD, Kindyle L. Brennan PhD, PT, Robert A. Probe MD & Michael L. Brennan MD

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  1. Donavan K. Murphy MD, MSc, MBA
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  2. Timmothy Randell MD
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  3. Kindyle L. Brennan PhD, PT
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  4. Robert A. Probe MD
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Correspondence to Donavan K. Murphy MD, MSc, MBA.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Murphy, D.K., Randell, T., Brennan, K.L. et al. Treatment and Displacement Affect the Reoperation Rate for Femoral Neck Fracture. Clin Orthop Relat Res 471, 2691–2702 (2013). https://doi.org/10.1007/s11999-013-3020-9

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  • DOI: https://doi.org/10.1007/s11999-013-3020-9

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