Primary Hemiarthroplasty for the Treatment of Basicervical Femoral Neck Fractures

Abstract

Purpose Basicervical femoral neck fractures are uncommon injuries that occur at the extracapsular base of the femoral neck at its transition with the intertrochanteric line. Controversy remains in the orthopedic literature as to the optimal method of treatment for this fracture type given the inherent instability and greater rate of implant failure with traditional fixation constructs. The purpose of this study is to quantify the incidence and preferred treatment methods of basicervical hip fractures at a single, regional, Level 1 trauma center and to identify differences in postoperative complications between treatment options. Methods The present study is a retrospective case series from a single regional health network, including 316 patients with hip fractures. Basicervical femoral neck fractures were identified. Reoperation rates within 90 days, implant failures or nonunions, postoperative ambulation distances and range of motion, and discharge dispositions were compared across patients grouped by surgical treatment with either cephalomedullary nail, sliding hip screw, or hemiarthroplasty (HA). Results Basicervical femoral neck fractures represented 6.6% of this study population. The cephalomedullary nail group demonstrated rates of implant failure and return to the operating room within 90 days of 40% (4/10) and 20% (2/10), respectively. No patients who underwent hemiarthroplasty experienced a failure of fixation or return to the operating room. Conclusions This study suggests a much lower rate of fixation failure or need for reoperation with hemiarthroplasty treatment compared to cephalomedullary nail construct for basicervical femoral neck fractures and may be an underutilized treatment method for this fracture type. The promising results seen with this case series should encourage further investigation into HA as a primary treatment for these uncommon, yet challenging, fractures.

Basicervical femoral neck fractures: an observational study derived from the Swedish Fracture Register

“…Such results suggest that bFNFs are positioned between transcervical FNFs (intracapsular) and trochanteric fractures (extracapsular), both anatomically and complication-wise [ 5 , 21 , 28 , 29 ]. Moreover, we observed a relatively high complication rate in patients undergoing primary arthroplasty compared with Davis et al, whose data suggests that hip arthroplasty is a valid treatment option in displaced bFNFs [ 15 ].…”

“…The treatment options reported in this study suggest a lack of agreement and that the current evidence is insufficient to guide clinicians [ 13 ]. Nevertheless, various IF and primary hip arthroplasty methods have shown satisfactory outcomes [ 9 , 15 ]. With a fracture line at the base of the femoral neck, the relationship between the joint capsule with its associated blood supply and the proximal fragment is unclear.…”

“…According to the Norwegian Hip Fracture Register, bFNFs account for 4.6% of all FNFs [ 11 ]. IF treatment with cannulated screws, sliding hip devices (SHDs), intramedullary nails (IMNs), and hip arthroplasty has been proposed [ 9 , 12 - 15 ]. Studies on bFNFs are uncommon and limited to case series and smaller cohorts.…”

Outcomes of Geriatric Hip Fractures in a Tertiary Referral Center in Malaysia During the COVID-19 Pandemic

“…With the enhancement of surgical knowledge and advancements in implant materials, effective and proven surgical interventions such as total hip arthroplasty, hemiarthroplasty and implant fixation are available to manage patients with geriatric hip fractures [6][7][8][9][10][11][12]. However, due to the fact that all the patients involved are elderly with multiple comorbidities, patients with geriatric hip fractures are prone to numerous complications such as thromboembolism, infection, gastrointestinal bleeding, delirium and functional loss [10][11][12][13][14][15][16][17]. Approximately 25% of older patients who sustain hip fractures die within one year, and about 13% die within six months after the trauma [5][6][7][8][9][10][11][12][13][14][15][16][17].…”

“…However, due to the fact that all the patients involved are elderly with multiple comorbidities, patients with geriatric hip fractures are prone to numerous complications such as thromboembolism, infection, gastrointestinal bleeding, delirium and functional loss [10][11][12][13][14][15][16][17]. Approximately 25% of older patients who sustain hip fractures die within one year, and about 13% die within six months after the trauma [5][6][7][8][9][10][11][12][13][14][15][16][17]. The recovery rate among those who survived is also poor, with only up to 50% of the patients regaining their ability to perform activities of daily living as prior to the fracture [15][16][17][18][19][20][21][22].…”