Outcomes of Delayed Arthroplasty After Failed Nonoperative Management of Valgus-Impacted Femoral Neck Fractures Are Comparable With Outcomes of Acute Arthroplasty.

OBJECTIVES

To compare surgical complication rates between delayed arthroplasty after failed nonoperative management and acute arthroplasty for valgus-impacted geriatric femoral neck fractures.

DESIGN

Retrospective review.

SETTING

Single academic Level I trauma center.

PATIENT SELECTION CRITERIA: Patients over 65 with valgus-impacted femoral neck fractures (AO/OTA 31-B1) from 2005 to 2024 treated with acute or delayed arthroplasty were retrospectively reviewed. Arthroplasty was considered delayed on or after day 7 of attempted nonoperative management.

OUTCOME MEASURES AND COMPARISONS: Postoperative complication rates, reoperations, and failure to return to baseline ambulatory status at final follow-up were assessed. Differences in patient demographics and outcomes between acute and delayed arthroplasty patients were assessed with chi-squared, Fisher exact, and independent samples t-tests (α = 0.05).

RESULTS

There were 47 patients treated with acute arthroplasty [35 (74.5%) female, age 83.5 ± 2 years, Charleston Comorbidity Index: 6.0, 40% independent weight bearing, follow-up: 8.5 months] and 21 treated with delayed arthroplasty [16 (76.2%) female, age 82.1 ± 4 years, Charleston Comorbidity Index: 6.1, 60% independent weight bearing, follow-up: 10.1 months]. Rates of medical [acute: 12 (25.5%), delayed: 3 (14.3%); P = 0.361] and surgical [acute: 5 (10.6%), delayed: 2 (9.5%); P = 0.999] complications did not differ between groups. The proportion of patients who did not return to baseline ambulatory status [acute: 14 (32.6%), delayed: 5 (26.3%); P = 0.847] and reoperation rates [acute: 2 (4.3%), delayed: 0 (0%); P = 0.999] were similar between groups. The postoperative mortality rate was 19.1% among the patients treated with acute arthroplasty and 19.0% among those treated with delayed arthroplasty, with no difference between groups ( P = 0.999).

CONCLUSIONS

There were no differences in postoperative complications, reoperations, failure of return to baseline ambulatory status, or mortality for geriatric patients who underwent delayed versus acute arthroplasty for valgus-impacted femoral neck fractures. There was no evidence of increased surgical morbidity in geriatric valgus-impacted femoral neck fractures after failed nonoperative management compared to patients treated with acute arthroplasty.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.