Arthroplasty versus fixation of femoral neck fractures in non-geriatric patients.

Abstract

Objectives: To compare arthroplasty versus fixation of femoral neck fractures (FNFs) in non-geriatric patients.

Methods: Design: Retrospective.

Setting: Level one trauma center.

Patients selection criteria: Adults with FNFs (OTA/AO 31-B) less than 65 years of age.

Outcome measures and comparisons: Arthroplasty and fixation groups were compared in terms of major complications (nonunion, deep infection, etc.) and reoperations. Subgroup analysis of total hip arthroplasty (THA) versus fixation of displaced FNFs was performed using propensity score matching. Variables associated with complications after fixation were evaluated for.

Results: Ninety-four patients were included; 47 received arthroplasty and 47 received fixation. The arthroplasty group was older (59.0 vs 40.0 years, p<0.0001), had more low-energy mechanisms (76.6% vs. 29.8%, p<0.0001), more displaced fractures (97.9% vs. 76.6%, p=0.003), and did not differ in proportion of males (61.7% vs. 70.2%, p=0.51), or follow-up duration (16.0 vs 10.6 months, p=0.08). The arthroplasty group was less likely to have a major complication (17.0% vs. 42.5%, p=0.01) or reoperation (12.8% vs. 31.9%, p=0.04). Patients treated with THA (n=19), compared to those with displaced fractures that were fixed (n=36), were older (61.0 vs. 37.5 years, p<0.0001), more likely to have low-energy injuries (63.1% vs. 25.0%, p=0.008), and less likely to have an ASA >2 (15.8% vs. 55.6%, p=0.008). After matching for these differences, there were 10 patients per group. The complication rate was lower in the THA group (0.0% vs. 50.0%, p=0.03) and the reoperation rate was similar (0.0% vs. 20.0%, p=0.47). Patients that had a complication after fracture fixation were more likely to have fracture comminution (70.0% vs. 22.2%, p=0.002), greater initial fracture displacement (14.5 vs. 6.7 mm; p=0.0002), and buttress plate fixation (20.0% vs. 0.0%; p=0.02).

Conclusions: Arthroplasty, compared to fixation, resulted in fewer major complications and reoperations. Major complications after fixation were associated with initial fracture displacement and comminution.

Level of evidence: 3, retrospective comparison.