Outcomes for Younger Patients with Femoral Neck Fractures

Background:There is a paucity of longer-term outcome data in younger adult patients who undergo fixation for an intracapsular hip fracture. The aims of this study were to evaluate the outcomes for young adult patients undergoing intracapsular hip fracture fixation and to assess factors associated with failure and patient-reported outcome measures (PROMs). Methods:From 2008 to 2018, 112 consecutive patients <= 60 years of age (mean age, 48 years [range, 20 to 60 years]; 54% male) were retrospectively identified as having undergone fixation of an intracapsular hip fracture. Displaced fractures (n = 81) were more common than nondisplaced or minimally displaced fractures (n = 31). Failure was defined as loss of fixation, nonunion, or osteonecrosis. PROMs that were assessed included the Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimension (EQ-5D) index and Visual Analogue Scale (EQ-VAS), and University of California Los Angeles (UCLA) Activity Scale. Results:Eighty-six patients (77%) had union without evidence of failure, and 26 patients (23%) had a failure, including loss of fixation (6 patients; 5.4%), nonunion (5 patients; 4.5%), and osteonecrosis (16 patients; 14.3%). Overall, 39 patients (35%) required secondary surgery, with hardware removal (21 patients; 18.8%) and total hip arthroplasty (21 patients; 18.8%) being the most frequent procedures. Long-term functional outcomes were obtained for 81 patients (72%) at a mean of 7 years (range, 2.8 to 12.8 years). The median OHS was 47 (interquartile range [IQR], 40-48), the median FJS was 75 (IQR, 49-85), the median EQ-5D index was 1.00 (IQR, 0.77-1.00), and the median EQ-VAS was 90 (IQR, 70-95). The mean UCLA score fell from 6.8 preinjury to 6.0 postinjury (p < 0.001). Compared with the patients who had primary union, those who had a complication had significantly lower median OHS scores (44.5 versus 47, p = 0.008), EQ-5D index scores (0.825 versus 1.00, p = 0.001), EQ-VAS scores (70 versus 90, p = 0.01), and UCLA scores (4.5 versus 6.5, p = 0.001). Conclusions:One in 4 young adult patients undergoing intracapsular hip fracture fixation had a failure. Failure was associated with inferior long-term function and health-related quality of life. Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.