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Comparative Study
. 2024 Aug 1;38(8):403-409.
doi: 10.1097/BOT.0000000000002828.

Optimal Fixation Strategies for Displaced Femoral Neck Fractures in Patients 18-59 Years of Age: An Analysis of 565 Cases Treated at 26 Level 1 Trauma Centers

Tom Roser  1 , Cory A Collinge  2 , Kashmeera Giga  1 , George F Lebus  3 , Michael J Beltran  4 , Brett Crist  5 , Stephen A Sems  6 , Michael J Gardner  7 , H Claude Sagi  4 , Michael T Archdeacon  4 , Hassan R Mir  8 , Andres Rodriguez-Buitrago  9 , Phillip Mitchell  10 , Paul Tornetta 3rd  11 ; Young Femoral Neck Fracture Working Group
Collaborators, Affiliations
Comparative Study

Optimal Fixation Strategies for Displaced Femoral Neck Fractures in Patients 18-59 Years of Age: An Analysis of 565 Cases Treated at 26 Level 1 Trauma Centers

Tom Roser et al. J Orthop Trauma. .

Abstract

Objectives: The objective of this study was to determine the difference in failure rates of surgical repair for displaced femoral neck fractures in patients younger than 60 years of age according to fixation strategy.

Design: This is a retrospective, comparative cohort study.

Setting: Twenty-six Level 1 North American trauma centers.

Patient selection criteria: Patients younger than 60 years of age with a displaced femoral neck fracture (OTA 31-B2, B3) undergoing surgical repair from 2005 to 2017.

Outcome measures and comparisons: Patient demographics, injury characteristics, repair methods used, and treatment failure (nonunion/failed fixation, avascular necrosis, and need for secondary surgery) were compared according to fixation strategy.

Results: Five hundred and sixty-five patients met inclusion criteria and were studied. The mean age was 42 years, 36% were female, and the average Pauwels' angle of fractures was 55 degrees. There were 305 patients treated with multiple cannulated screws (MCS) and 260 treated with a fixed-angle (FA) construct. Treatment failures were 46% overall, but was more likely to occur in MCS constructs versus FA devices (55% vs. 36%, P < 0.001). When FA constructs were substratified, the use of a sliding hip screw with addition of a medial femoral neck buttress plate (FNBP) and "antirotation" (AR) screw demonstrated better results than either FNBP or AR screw alone or neither with the lowest overall construct failure rate of 11% (P < 0.036).

Conclusions: Historically used fixation constructs for femoral neck fractures (eg, multiple cannulated screws and sliding hip screw) in young and middle-aged adults performed poorly compared with more recently proposed constructs, including those using a medial femoral neck buttress plate and an antirotation screw. Fixed-angle constructs outperformed multiple cannulated screws overall, and augmentation of fixed-angle constructs with a medial femoral neck buttress plate and antirotation screw improved the likelihood of successful treatment. Surgeons should prioritize fixation decisions when repairing displaced femoral neck fractures in patients.

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

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Conflict of interest statement

The authors report no conflict of interest.

References

    1. Collinge CA, Finlay A, Rodriguez-Buitrago A, et al. Treatment failure in femoral neck fractures in adults less than 50 years of age: analysis of 492 patients repaired at 26 North American Trauma Centers. J Orthop Trauma. 2022;36:271–279.
    1. Probe R, Ward R. Internal fixation of femoral neck fractures. J Am Acad Orthop Surg. 2006;14:565–571.
    1. Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury. 2015;46:484–491.
    1. Wang CT, Chen JW, Wu K, et al. Suboptimal outcomes after closed reduction and internal fixation of displaced femoral neck fractures in middle-aged patients: is internal fixation adequate in this age group? BMC Musculoskelet Disord. 2018;19:190.
    1. Collinge CA, Harris P, Sagi HC, et al. Comparative analysis of supplemental medial Buttress Plate fixation for high-energy displaced femoral neck fractures in young adults. J Orthop Trauma. 2023;37:207–213.