Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: short-term results from a geriatric trauma registry

Abstract

Purpose: To determine whether internal fixation (IF) or hip arthroplasty (HA) is associated with superior outcomes in geriatric nondisplaced femoral neck fracture (FNF) patients.

Methods: Data from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) were analyzed (IF Group 449 and HA Group 1278 patients). In-hospital care and a 120-day postoperative follow-up were conducted. Primary outcomes, including mobility, residential status, reoperation rate, and a generic health status measure (EQ-5D score), and the secondary outcome of mortality were compared between groups. Multivariable analyses were performed to assess independent treatment group associations (odds ratios, ORs) with the primary and secondary end points.

Results: Patients in the HA group were older (83 vs. 81 years, p < 0.001) and scored higher on the Identification of Seniors at Risk screening (3 vs. 2, p < 0.001). We observed no differences in residential status, reoperation rate, EQ-5D score, or mortality between groups. After adjusting for key covariates, including prefracture ambulatory capacity, the mobility of patients in the HA group was more frequently impaired at the 120-day follow-up (OR 2.28, 95% confidence interval = 1.11-4.74).

Conclusion: Treatment with HA compared to treatment with IF led to a more than twofold increase in the adjusted odds of impaired ambulation at the short-term follow-up, while no significant associations with residential status, reoperation rate, EQ-5D index score, or mortality were observed. Thus, IF for geriatric nondisplaced FNFs was associated with superior mobility 120 days after surgery. However, before definitive treatment recommendations can be made, prospective, randomized, long-term studies must be performed to confirm our findings.

Keywords: Elderly; Health-related quality of life; Hip fracture; Mobility; Reoperation; Treatment.

Fig. 1

Study design and patient selection flow chart. ATR-DGU, Registry for Geriatric Trauma of the German Trauma Society; FNF femoral neck fracture, HA hip arthroplasty, IF internal fixation

Fig. 2

Multivariable analyses with adjusted odds ratios and 95% confidence intervals (CI) for the surgical treatment of hip arthroplasty as predictors of in-hospital mortality as well as impaired ambulation, institutionalization, reoperation, and mortality at follow-up. The model was adjusted for sex, age, prefracture residential and mobility status, ISAR score, use of prefracture anticoagulation medication, and ASA class. ASA class, American Society of Anesthesiologists classification; ISAR, Identification of Seniors at Risk. *p < 0.05. Data availability: ¹n = 375, ²n = 351, ³n = 484, ⁴n = 990, ⁵n = 378