Long-Term Revision-Free Survival Following Operative Fixation of Femoral Neck Fractures in Young Adults.

Abstract

Objectives: To identify the rate of fixation failure following femoral neck fracture (FNF) fixation in young adults within a national database.

Methods: Design: Retrospective cohort study.

Setting: National all-payer claims database.

Patient selection criteria: Adults between 18 and 49 years of age who underwent operative fixation for FNF (AO/OTA 31-B) between January 2010 and April 2019 were identified.

Outcome measures and comparisons: The primary outcome measure was five-year risk of revision surgery for fixation failure following operative management of FNF. Additional data variables included rate of fixation failure following open versus closed reduction techniques and the rate of revision fixation, intertrochanteric osteotomy for nonunion or malunion, and conversion to arthroplasty.

Results: A total of 3,534 young adults underwent operative fixation of a FNF during the study period. The mean age of the study population was 41.1 +/- 3.91 years (18-49) and a majority were male (52.6%). The five-year revision-free survival of young adults who underwent operative fixation for FNF was 86.1% (95% CI 85.5-89.1%). Four-hundred ninety-two patients (13.9%) required revision surgical intervention for fixation failure, including 210 (5.9%) revision fixation procedures and 21 (0.6%) intertrochanteric osteotomies; two hundred sixty-one (7.4%) patients underwent conversion to arthroplasty. There was no significant difference in rate of fixation failure when comparing open (n=392, 14.9%) and closed (n=100, 13.3%) reduction techniques (p=0.351).

Conclusions: Following operative management of FNF in young adults, fixation failure due to avascular necrosis, nonunion/malunion, or posttraumatic arthritis occurred at a rate of 13.9%. There was no difference in the rate of treatment failure between open and closed reduction.

Level of evidence: Therapeutic Level IV.