The Effects of Surgical Repair Devices in Middle Aged Adults (50-59 Years of Age) with Femoral Neck Fractures

Abstract

Purpose: Features of femoral neck fractures vary according to factors including age and mechanism of injury. In older patients (>60 years old), poor bone quality, the inability to limit weight bearing, along with co-morbidities where secondary surgeries may not be tolerated, often limits the utility of fracture repair in favor of replacement. Mechanism of femoral neck fractures in young adults in often higher energy, leading to atypical fracture angles and fracture comminution. Although this presents biomechanical challenges for implants after fracture repair, young adult patients (e.g. < 50 years old) are usually treated with repair as outcomes of arthroplasty in young patients are not well-defined. There remains a "middle-aged" group of 50-59-year-old patients in which femoral neck fracture mechanism and bone quality is highly variable. Decision for replacement versus repair becomes ill defined and more discretionary action is placed in the hands of the surgeon. Therefore, we asked if there are mechanical considerations in the fracture mechanism and surgical implants used that affect clinical outcomes. Potentially highly impactful decisions are made regarding the hardware and methodology used for augmentation, all of which could contribute to likelihood of success. Methods: This is a retrospective study of patients 50 to 59 years old with a femoral neck fracture treated with surgical repair between 2005 and 2017 at 26 Level 1 trauma centers in North America. A database including approximately 600 patients was evaluated for injury mechanism, internal fixation method implemented, and success of that intervention. Specific mechanical variables analyzed included fracture pattern: (vertical fracture angle, presence of fracture comminution) and stability of fracture repair: (quality of surgical realignment, use of established benchmarks for fracture repair including screw lengths, depths, numbers and placement). Results: Preliminary results following the recent conclusion of data collection indicated that of the 350 qualifying patients for analysis, higher success rates are suggested at 6 months postoperatively in regards to part placement as opposed to the internal fixation device chosen. Conclusion: As data analysis continues, this demonstrates a need for targeted evaluation and comparison of surgical reduction quality standards in femoral neck fracture repair while controlling for patient co-morbidities in hopes of identifying standard benchmarks of surgical placement. Future impact of this comprehensive database will allow for further investigation on this multifactorial topic.