Thurs., 10/4/12 Hip Fractures, PAPER #34, 4:12 pm OTA-2012
Outcomes After Treatment of Femoral Neck Fractures in Young Patients
Andrew N. Pollak, MD1; Emily Hui, MPH1; Renan C. Castillo, MS1; Bingfang Zeng, MD2;
Dong Wang, MD2; Baotong Ma, DO2;
1R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA;
2The Shanghai Sixth People’s Hospital, Shanghai Kiao Tong University, Shanghai, China
Purpose: This study was undertaken to determine the contribution of clinical complications (osteonecrosis [ON], malunion, nonunion, and patient-reported pain) to outcomes after closed reduction and percutaneous screw fixation of displaced femoral neck fractures in young patients.
Methods: This prospective observational study was conducted at 3 high-volume Asian trauma centers. Of the 126 patients aged 18 to 55 years with eligible femoral neck fractures, 91 (72%) with complete 12-month follow-up were studied. Patients were followed according to standard of care for at least 12 months after injury to observe any clinical complications. Age, sex, initial injury fracture classifications (Pauwel and Garden), and baseline Short Form 36 (SF-36) general health questionnaire scores were recorded at time of enrollment. Follow-up data included radiographic evaluation for evidence of ON, nonunion and/or malunion, SF-36, and a visual analog scale (VAS) score for pain. SF-36 Physical and Mental Component Summary scores (PCS and MCS, respectively) were calculated.
Results: The mean age of the 91 patients with completed 12-month follow-up visits was 44.4 years (range, 20-55) and 48.4% were females. Analysis of clinical outcomes demonstrated 6.6% incidence of ON, 6.6% nonunion, 4.4% malunion, and 1.1% of patients with a VAS pain score >3. For the overall study group, mean PCS was 47 and mean MCS was 51.3. This compares to PCS population norms for this country ranging from 52 to 53.3, and MCS population norms ranging from 44.9 to 47.5. Clinical subgroup analysis indicated that patients with no observed complications had mean PCS and MCS scores of 48.4 and 51.1, respectively, while patients with any complications (12.1% of the patients) had mean PCS and MCS scores of 37.3 and 52.5, respectively. A multiple variable regression modeling approach was used to identify the contribution of each complication to outcome. None of the complications were significantly associated with lower MCS. Malunion was significantly associated with a 14.6-point reduction in the PCS (P = 0.002). Nonunion showed a trend toward significant reduction in PCS by 6.6 points (P = 0.09).
Conclusion: Femoral neck fractures in young patients are rare injuries. Traditional treatment recommendations include anatomic reduction and stable internal fixation to decrease the risk of complications. Most North American surgeons recommend an open approach to maximize the chance of achieving anatomic restoration of alignment and stable fixation. In other areas of the world, the simpler procedure of closed reduction and percutaneous screw fixation is more commonly employed with anecdotes indicating that good results can be achieved. Our preliminary study results demonstrate that complication rates overall were relatively low and outcomes good (SF-36 scores similar to population norms) with closed reduction. While patients with complications, particularly malunions, had significantly worse physical function outcomes, MCS scores were not different when comparing groups with and without complications. This is different than findings of many studies of mental function after trauma and may reflect better social support networks in the population studied.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.