Short-to Medium-term Results of Displaced Femoral Neck Fractures in Patients Less than 50 Years of Age Undergoing Repair: Comparison of Open vs. Closed Reduction.

OBJECTIVES

To compare the clinical outcomes of open vs. closed reduction methods for femoral neck fractures (FNFs) in young patients treated with fracture repair.

METHODS

Design

Multicenter retrospective cohort study.

SETTING

Twenty-six North American Level 1 trauma centers.

PATIENT SELECTION CRITERIA: Skeletally mature patients aged <50 years with displaced FNFs (OTA/AO type 31B) undergoing surgical repair and having minimum follow-up >6 months, except in cases where major complications occurred earlier.

INTERVENTION: Open vs. closed fracture reduction.

MAIN OUTCOME MEASUREMENTS: The primary outcome of "major complication" was defined as nonunion/failed fixation, osteonecrosis, malunion (vertical or femoral neck shortening of ≥15 mm) and/or subsequent major reconstructive surgery was compared by reduction method using chi-squared tests and risk-adjusted binary mixed effects regression models.

RESULTS

A total of 290 patients with FNFs were included in the study, 107 treated with closed reduction (average follow-up 27.1 months [range, 4.1 to 159.5 months]) and 183 treated with open reduction and (average follow-up 22.4 months [range, 3.7 to 141.3 months], P=0.105). Sex distribution showed no difference between the groups, with 25.5% of the closed group, and 29.0% of the open cohort being female (P=0.615). Patients who received open reduction were younger than patients who received closed reductions (mean age 35.6±8.8 vs. 39.5±8.0 years, P<0.001) and had fewer cases of cases of diabetes mellitus (2.2% vs. 8.6%, P=0.027). Overall, adverse events were observed following 57.0% of closed reduction reductions vs. 54.1% of open reductions (P=0.890). No differences were seen in the frequency of defined failure modes, including failed fixation/nonunion (33.6% closed vs. 35.0% open, P=0.919), osteonecrosis (21.5% closed vs. 14.2% open, P=0.151), malunion (17.8% closed vs. 14.8% open, P=0.611), or major reconstructive surgery (33.6% closed vs. 36.6% open, P=0.702).

CONCLUSIONS

Open and closed reductions of FNFs in patients <50 years old were associated with similar rates of repair failure.

LEVEL OF EVIDENCE: Level III (Therapeutic).