Abstract
Introduction
Few studies have evaluated treatment of displaced femoral neck fractures in patients younger than 65 years, and risk factors for AVN or nonunion have not been clearly delineated within this age range.
Method
To determine factors associated with avascular necrosis of the femoral head (AVN) and nonunion in patients younger than 65 years with displaced femoral neck fractures treated with reduction and internal fixation, we conducted a retrospective study of 29 displaced femoral neck fractures in 29 consecutive patients treated at a single institution. The influence of age, trauma energy, open reduction, and time from fracture to treatment on development of AVN and nonunion was evaluated.
Results
Patients who developed AVN were significantly older and suffered lower energy trauma than cases without AVN. No recorded variables were associated with nonunion. Logistic regression determined that only age was independently associated with AVN. Age was a good predictor for developing AVN, with a C statistics of 0.861, and a best cutoff determined at 53.5 years.
Conclusion
Patients between 53.5 and 65 years presented a higher risk of AVN. A primary arthroplasty should be considered in this subgroup.
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References
Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P 3rd, Obremskey W, Koval KJ, Nork S, Sprague S, Schemitsch EH, Guyatt GH (2003) Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am 85-A:1673–1681
Ray NF, Chan JK, Thamer M, Melton LJ 3rd (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35. doi:10.1359/jbmr.1997.12.1.24
Heetveld MJ, Rogmark C, Frihagen F, Keating J (2009) Internal fixation versus arthroplasty for displaced femoral neck fractures: what is the evidence? J Orthop Trauma 23:395–402. doi:10.1097/BOT.0b013e318176147d
Lofthus CM, Osnes EK, Falch JA, Kaastad TS, Kristiansen IS, Nordsletten L, Stensvold I, Meyer HE (2001) Epidemiology of hip fractures in Oslo, Norway. Bone 29:413–418
Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ (2004) Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am 86-A:1711–1716
Masson M, Parker MJ, Fleischer S (2003) Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev CD001708. doi:10.1002/14651858.CD001708
Aleem IS, Karanicolas PJ, Bhandari M (2009) Arthroplasty versus internal fixation of femoral neck fractures: a clinical decision analysis. Ortop Traumatol Rehabil 11:233–241
Healy WL, Iorio R (2004) Total hip arthroplasty: optimal treatment for displaced femoral neck fractures in elderly patients. Clin Orthop Relat Res (429):43–48
Keating JF, Grant A, Masson M, Scott NW, Forbes JF (2006) Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am 88:249–260. doi:10.2106/JBJS.E.00215
Ly TV, Swiontkowski MF (2008) Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am 90:2254–2266
Gautam VK, Anand S, Dhaon BK (1998) Management of displaced femoral neck fractures in young adults (a group at risk). Injury 29:215–218
Loizou CL, Parker MJ (2009) Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1023 patients. Injury 40:1143–1146. doi:10.1016/j.injury.2008.11.003
Parker MJ, Raghavan R, Gurusamy K (2007) Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res 458:175–179. doi:10.1097/BLO.0b013e3180325a42
Upadhyay A, Jain P, Mishra P, Maini L, Gautum VK, Dhaon BK (2004) Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction. J Bone Joint Surg Br 86:1035–1040
Swiontkowski MF, Winquist RA, Hansen ST Jr (1984) Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg Am 66:837–846
Barnes R, Brown JT, Garden RS, Nicoll EA (1976) Subcapital fractures of the femur. A prospective review. J Bone Joint Surg Br 58:2–24
Graham J (1968) Early or delayed weight-bearing after internal fixation of transcervical fracture of the femur. A clinical trial. J Bone Joint Surg Br 50:562–569
Tooke SM, Favero KJ (1985) Femoral neck fractures in skeletally mature patients, fifty years old or less. J Bone Joint Surg Am 67:1255–1260
Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN (2002) Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Am 84-A:1605–1612
Protzman RR, Burkhalter WE (1976) Femoral-neck fractures in young adults. J Bone Joint Surg Am 58:689–695
Manninger J, Kazar G, Fekete G, Nagy E, Zolczer L, Frenyo S (1985) Avoidance of avascular necrosis of the femoral head, following fractures of the femoral neck, by early reduction and internal fixation. Injury 16:437–448
Manninger J, Kazar G, Fekete G, Fekete K, Frenyo S, Gyarfas F, Salacz T, Varga A (1989) Significance of urgent (within 6 h) internal fixation in the management of fractures of the neck of the femur. Injury 20:101–105
Gerber C, Strehle J, Ganz R (1993) The treatment of fractures of the femoral neck. Clin Orthop Relat Res (292):77–86
Damany DS, Parker MJ, Chojnowski A (2005) Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury 36:131–141. doi:10.1016/j.injury.2004.05.023
Zetterberg CH, Irstam L, Andersson GB (1982) Femoral neck fractures in young adults. Acta Orthop Scand 53:427–435
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Schweitzer, D., Melero, P., Zylberberg, A. et al. Factors associated with avascular necrosis of the femoral head and nonunion in patients younger than 65 years with displaced femoral neck fractures treated with reduction and internal fixation. Eur J Orthop Surg Traumatol 23, 61–65 (2013). https://doi.org/10.1007/s00590-011-0936-1
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DOI: https://doi.org/10.1007/s00590-011-0936-1