The Impact of Additional Fractures and Polytrauma on Complications in Patients Undergoing Femoral Neck Fracture Fixation.

Abstract

Background: While there have been significant advancements in recent years, complications following fixation for femoral neck fractures remain a concern. This retrospective cohort study aimed to investigate the influence of polytrauma and additional fractures on the occurrence of complications in patients who underwent surgical fixation for femoral neck fractures. The study focused on analyzing patient demographics, comorbidities, fracture classifications, fixation methods, and the likelihood of experiencing post-operative complications, with a specific emphasis on the impact of polytrauma and additional fractures.

Methods: This retrospective cohort study analyzed data from medical records and radiographs of patients who underwent surgical fixation for femoral neck fractures at a tertiary care center between 2007 and 2020. A total of 58 patients met inclusion criteria and were assessed based on their medical history, comorbidities, fracture classification, fixation method, and the occurrence of complications such as osteonecrosis, non-union, limb length discrepancy, and conversion to Total Hip Arthroplasty (THA). Among the patients, 36 received Cancellous Screw (CS) fixation, 12 underwent Sliding Hip Screw (SHS) fixation, while the remaining 10 patients who underwent different fixation methods were excluded from the analysis due to the heterogeneity of the group.

Results: Demographic characteristics and comorbidities were similar between the CS and SHS fixation groups. The overall complication rate for CS fixation was 16.7% (6/36 patients), while the rate for SHS fixation was 33.3% (4/12 patients). However, when considering the presence of polytrauma and additional fractures, a significant association with increased complication rates was observed. Cox proportional regression analysis revealed that the absence of polytrauma/additional fractures significantly reduced the complication rates by more than 90% (Hazard ratio (HRpolytrauma)=0.01, P value = 0.01). This highlights the substantial impact of polytrauma and additional fractures on complications in femoral neck fracture fixation surgeries.

Conclusion: This study emphasizes the need for thorough evaluation and tailored management strategies for patients with femoral neck fractures associated with polytrauma or additional fractures to minimize the complications of femoral neck fracture surgery. Further research is warranted to explore potential preventive measures and optimized treatment approaches for this high-risk patient subset of the femoral neck fracture population. Level of Evidence: III.