Rate of conversion to secondary arthroplasty after femoral neck fractures in 796 younger patients treated with internal fixation: a Swedish national register-based study

Abstract

Background and purpose: In younger patients with a femoral neck fracture (FNF), internal fixation is the recommended treatment regardless of displacement. Healing complications are often treated with arthroplasty. We determined the rate of conversion to arthroplasty up to 5 years after fixation of either undisplaced FNFs (uFNFs) or displaced FNFs (dFNFs).Patients and methods: The study was based on prospectively collected data from the Swedish Fracture Register (SFR) and the Swedish Arthroplasty Register (SAR). FNFs in patients aged < 60 treated with parallel pins/screws or sliding hip screws (SHS) registered in SFR 2012–2018 were cross-referenced with conversions to arthroplasty registered in SAR until 2019. The cumulative conversion and mortality rates were determined by Kaplan–Meier analyses and patient- and surgery-dependent risk factors for conversion by Cox regression analyses.Results: We included 407 uFNFs and 389 dFNFs (median age 52, 59% men). The 1-year conversion rate was 3% (95% CI 1–5) for uFNFs and 9% (CI 6–12) for dFNFs. Corresponding results at 5 years were 8% (CI 5–11) and 25% (CI 20–30). Besides a displaced fracture, age 50–59 was associated with an increased rate of conversion in uFNFs. This older group also had a higher mortality rate, compared with patients aged < 50. There was no sex difference for mortality.Interpretation: Adults aged under 60 with uFNFs and dFNFs face an 8–25% risk, respectively, of conversion to arthroplasty within 5 years after internal fixation. This is new and pertinent information for surgeons as well as patients.

Assessing osteonecrosis of the femoral head after internal fixation of femoral neck fractures in young patients with fixation implants in situ: the value of MARS MRI in relation to conventional radiography and patient-reported outcomes

“…Our study is the first to combine the ONFH-related findings on conventional radiography and MARS MRI and compare them with PROs after FNF. We consider our cohort to represent the most relevant age group for this study, as FNFs in this age group are treated primarily with internal fixation (2).…”

“…Osteonecrosis of the femoral head (ONFH) is a well-known complication after internal fixation of a femoral neck fracture (FNF) (1). For young patients and patients with undisplaced fractures, internal fixation is still the most common treatment (2). Development of ONFH can be devastating, leading to pain, disability, and need for secondary surgery (3,4).…”

Inter-departmental variation in surgical treatment of proximal femoral fractures: A nationwide observational cohort study

“…In most patients current evidence cannot detect any differences of clinical importance between THA and HA approaches [ 15 ]. Notable is the high age cut-off (60 to 70 years) [ 16 , 17 ] in Scandinavia for using IF for displaced FNFs. Thus, many healthy “young old” will undergo IF rather than (total) arthroplasty.…”

Multidimensional Fluoroscopy to Assess Closed Reduction in Displaced Young Femoral Neck Fractures

“…Therefore, anatomic reduction and compression is paramount to promote successful primary bone healing because these injuries are associated with high complication rates including avascular necrosis and nonunion rates of 8% to 23%. [3][4][5][6] Reduction quality in the treatment of these injuries has been emphasized since the onset of their operative management. Studies have demonstrated worse fracture reduction is associated with poorer outcomes 5,[7][8][9] .…”

“…Therefore, anatomic reduction and compression is paramount to promote successful primary bone healing because these injuries are associated with high complication rates including avascular necrosis and nonunion rates of 8% to 23%. 3-6…”