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Is percutaneous screw fixation really superior to non-operative management after valgus-impacted femoral neck fracture: a retrospective cohort study

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Abstract

Purpose

The optimal management of valgus-impacted femoral neck fractures remains controversial. Internal fixation is associated with significant rates of re-operation, while historical non-operative management strategies consisting of prolonged bed rest also resulted in patient morbidity. Our hypothesis was that screw fixation would have comparable failure rates to non-operative treatment and immediate mobilization for valgus-impacted femoral neck fractures.

Methods

Retrospective cohort at a single academic Level I trauma center of patients with valgus-impacted femoral neck fractures (AO/OTA 31-B1) treated with percutaneous screw fixation (n = 97) or non-operatively (n = 28). Operative treatment consisted of percutaneous screw fixation. Non-operative treatment consisted of early mobilization. The primary outcome was a salvage operation. Patient demographics were assessed between groups.

Results

More non-operatively treated patients were permitted unrestricted weight-bearing (WBAT; p = 0.002). There was no increase in complication rates or mortality, and return to previous ambulatory status was comparable between operatively and non-operatively treated patients. 35.7% (10/28) of non-operatively treated patients underwent a subsequent operation, compared to 15.5% (15/97) of patients with screw fixation (p = 0.03). Only WBAT was independently associated with treatment failure (OR 3.1, 95%CI 1.2–8.3, p =0.02). WBAT was predictive of treatment failure only in the non-operatively treated group (64.3%, 9/14 WBAT vs 8.3%, 1/12 partial, p =0.005).

Conclusion

After controlling for weight-bearing restrictions, we found no difference in failure rates between non-operative treatment and screw fixation. Non-operative treatment with partial weight-bearing had low failure rates, comparable complication and mortality rates, and equivalent functional outcomes to operative treatment and is reasonable if a patient would like to avoid surgery and accepts the risk of subsequent arthroplasty. Overall, there were relatively high failure rates in all groups.

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Funding

MG: AAOS: Board or committee member; American Orthopaedic Association: Board or committee member; Conventus: Paid consultant; Stock or stock Options; Current Opinion in Orthopaedics: Editorial or governing board; Genesis Innovations Group: Stock or stock Options; Globus Medical: Paid consultant; Imagen Technologies: Stock or stock Options; Intelligent Implants: Stock or stock Options; Journal of Bone and Joint Surgery—American: Publishing royalties, financial or material support; Journal of Orthopaedic Trauma: Editorial or governing board. KCI: Paid consultant; Paid presenter or speaker; Medtronic: Research support; Orthopaedic Research Society: Board or committee member; Orthopaedic Trauma Association: Board or committee member; OsteoCentric: Paid consultant; Research support; SI-Bone: Paid consultant; SmartMedical Devices: Research support; StabilizOrtho: Paid consultant; Synthes: IP royalties; Paid consultant; Wolters Kluwer Health—Lippincott Williams & Wilkins: Publishing royalties, financial or material support Zimmer: Research support. JB: Conventus (research), Innomed (royalty), Depuy, Globus, KCI, Stryker (paid consultant), JOT (editorial board).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, 300 Pasteur Drive, Room R144, Stanford, CA, USA

    L. Henry Goodnough, Harsh Wadhwa, Andrew T. Fithian, Malcolm R. DeBaun & Sean T. Campbell

  2. Department of Orthopaedic Surgery, 450 Broadway Ave, Pavilion A, Redwood City, CA, 94063, USA

    Michael J. Gardner & Julius A. Bishop

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  1. L. Henry Goodnough
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Goodnough, L.H., Wadhwa, H., Fithian, A.T. et al. Is percutaneous screw fixation really superior to non-operative management after valgus-impacted femoral neck fracture: a retrospective cohort study. Eur J Orthop Surg Traumatol 31, 65–70 (2021). https://doi.org/10.1007/s00590-020-02742-y

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