Outcomes for Younger Patients with Femoral Neck Fractures.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2024-12-23 DOI:10.2106/JBJS.23.00582

Boris C Wagner, William M Oliver, Katrina R Bell, Chloe E H Scott, John F Keating, Timothy O White, Nick D Clement, Andrew D Duckworth

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引用次数: 0

Abstract

Background: There is a paucity of longer-term outcome data in younger adult patients who undergo fixation for an intracapsular hip fracture. The aims of this study were to evaluate the outcomes for young adult patients undergoing intracapsular hip fracture fixation and to assess factors associated with failure and patient-reported outcome measures (PROMs).

Methods: From 2008 to 2018, 112 consecutive patients ≤60 years of age (mean age, 48 years [range, 20 to 60 years]; 54% male) were retrospectively identified as having undergone fixation of an intracapsular hip fracture. Displaced fractures (n = 81) were more common than nondisplaced or minimally displaced fractures (n = 31). Failure was defined as loss of fixation, nonunion, or osteonecrosis. PROMs that were assessed included the Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimension (EQ-5D) index and Visual Analogue Scale (EQ-VAS), and University of California Los Angeles (UCLA) Activity Scale.

Results: Eighty-six patients (77%) had union without evidence of failure, and 26 patients (23%) had a failure, including loss of fixation (6 patients; 5.4%), nonunion (5 patients; 4.5%), and osteonecrosis (16 patients; 14.3%). Overall, 39 patients (35%) required secondary surgery, with hardware removal (21 patients; 18.8%) and total hip arthroplasty (21 patients; 18.8%) being the most frequent procedures. Long-term functional outcomes were obtained for 81 patients (72%) at a mean of 7 years (range, 2.8 to 12.8 years). The median OHS was 47 (interquartile range [IQR], 40-48), the median FJS was 75 (IQR, 49-85), the median EQ-5D index was 1.00 (IQR, 0.77-1.00), and the median EQ-VAS was 90 (IQR, 70-95). The mean UCLA score fell from 6.8 preinjury to 6.0 postinjury (p < 0.001). Compared with the patients who had primary union, those who had a complication had significantly lower median OHS scores (44.5 versus 47, p = 0.008), EQ-5D index scores (0.825 versus 1.00, p = 0.001), EQ-VAS scores (70 versus 90, p = 0.01), and UCLA scores (4.5 versus 6.5, p = 0.001).

Conclusions: One in 4 young adult patients undergoing intracapsular hip fracture fixation had a failure. Failure was associated with inferior long-term function and health-related quality of life.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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年轻股骨颈骨折患者的预后。

背景：缺乏接受髋囊内骨折固定治疗的年轻成年患者的长期预后数据。本研究的目的是评估接受髋部骨折囊内固定的年轻成年患者的结果，并评估与失败和患者报告的结果测量（PROMs）相关的因素。方法：2008 - 2018年，连续112例年龄≤60岁的患者(平均年龄48岁[范围20 ~ 60岁]；（54%男性）被回顾性确认为髋关节囊内骨折内固定。移位骨折（n = 81）比非移位或轻度移位骨折（n = 31）更常见。失败被定义为失去固定、骨不连或骨坏死。评估的PROMs包括牛津髋关节评分（OHS）、遗忘关节评分（FJS）、EuroQol 5维指数（EQ-5D）和视觉模拟量表（EQ-VAS），以及加州大学洛杉矶分校（UCLA）活动量表。结果：86例（77%）患者愈合无失败证据，26例（23%）患者愈合失败，包括固定物丢失(6例；5.4%)，骨不连(5例；4.5%)，骨坏死(16例；14.3%)。总体而言，39例患者（35%）需要二次手术，其中硬体取出（21例）；18.8%)和全髋关节置换术(21例；18.8%)是最常见的手术。81例（72%）患者获得了平均7年（2.8至12.8年）的长期功能结局。OHS中位数为47（四分位间距[IQR]， 40-48）， FJS中位数为75 (IQR, 49-85)， EQ-5D指数中位数为1.00 (IQR, 0.77-1.00)， EQ-VAS中位数为90 （IQR, 70-95）。平均UCLA评分从损伤前的6.8分下降到损伤后的6.0分（p < 0.001）。与初次愈合的患者相比，有并发症的患者OHS评分中位数（44.5比47，p = 0.008）、EQ-5D指数评分中位数（0.825比1.00,p = 0.001）、EQ-VAS评分中位数（70比90，p = 0.01）和UCLA评分中位数（4.5比6.5,p = 0.001）均显著降低。结论：1 / 4的年轻成人髋部骨折囊内固定失败。失败与较差的长期功能和健康相关的生活质量有关。证据等级：治疗性III级。有关证据水平的完整描述，请参见作者说明。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.