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    How Do Younger Patients Fare after Internal Fixation of Femoral Neck Fracture?

    Dr. Gerard Slobogean comments on a study he and his colleagues from the University of Maryland School of Medicine conducted to quantify the reoperation rate and timing of reoperation in femoral neck fracture patients age 50 and younger.

    Femoral neck fractures most commonly occur in older patients, but they are becoming more common in younger patients as a result of high-energy trauma and high-stress athletic activities. In most cases, fractures in younger patients are treated with internal fixation.

    The problem: These patients may need a second operation to remove hardware causing pain or to manage avascular necrosis or femoral neck non-union. In some cases, internal fixation is converted to total hip arthroplasty (THA).

    But just how likely is it for patients to need a reoperation, and at what point following the initial fixation will it typically occur?

    To find out, Gerard Slobogean, MD, and his colleagues at the University of Maryland School of Medicine conducted a population-based retrospective cohort study that included nearly 800 patients age 50 and younger who had undergone internal fixation for a femoral neck fracture between 1997 and 2013.

    Their study quantifying the reoperation rate and timing of reoperation in these patients was reported at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgery in New Orleans, where it was named one of the meeting’s “game-changing” papers.

    Why is this study a game-changer? “There has been increasing interest in primary total joint arthroplasty as a treatment option for some severe periarticular fractures in select patients, given the improved longevity and outcomes of arthroplasty implants,” Dr. Slobogean said. “Femoral neck fracture is one such example.

    “The question becomes, in what type of patient might this be an intervention that gives them a better chance of success? Part of that answer involves having good information about the long-term rate of reoperation and conversion to THA if the fracture is fixed with internal fixation. That is what we have provided with this paper.”

    Dr. Slobogean and his colleagues found an overall reoperation rate of 33.6%, primarily for hardware removal (n=192, 54.7%) or conversion to THA (n=102, 29.1%). One quarter of patients had a reoperation within 3.5 years of the first procedure, and about 10% underwent conversion to THA within 5 years.

    The researchers were surprised to find that “neither age, nor gender, nor hospital volume were associated with a higher probability of reoperation or conversion to THA,” Dr. Slobogean said. “This may have been a function of our inability to distinguish displaced versus non-displaced fractures, but nevertheless, it is an interesting finding when considering this cohort as a whole.”

    The study, Dr. Slobogean said, should help surgeons discuss treatment with their younger femoral neck fracture patients. “Our findings provide information that surgeons can use in educating patients about their fracture, and in deciding on their treatment strategy,” he said.

    “The literature is clear with regard to the long-term survival and complications of THA in various age groups. With this paper, we now have similar information for internal fixation of femoral neck fractures in younger patients.”

    Source

    Stockton DJ, O’Hara LM, O’Hara NN, Lefaivre KA, O’Brien PJ, Slobogean G. High Rate of Re-Operation and Conversion to Total Hip Arthroplasty after Internal Fixation of Young Femoral Neck Fractures: A Population-Based Study (Paper 592-GC). Presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons, March 6-10, 2018, New Orleans, Louisiana.

    Disclosures

    The study authors have no disclosures relevant to this paper.