Treatment of femoral neck fractures in patients 45–64 years of age. Issue 3 (March 2019)

• Record Type: Journal Article
• Authors: Johnson, Joey P.; Kleiner, Justin; Goodman, Avi D.; Gil, Joseph A.; Daniels, Alan H.; Hayda, Roman A.
• Is Part Of: Injury. Volume 50:Issue 3(2019)
• Page Start: 708
• Page End: 712
• Publication Date: 2019-03
• Subjects: Trauma -- Femoral neck fractures -- Arthroplasty; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2018.11.020
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: From 2002–2014 the overall rate of femoral neck fractures in patients aged 45–64 increased significantly. From 2002–2014, the rate of total hip arthroplasty for femoral neck fractures in patients aged 45–64 increased by a rate of greater than 400%. The total hospital stay, hospital cost and complication rate for patients aged 45–64 is higher for those receiving total hip arthroplasty. Older patients in the age 45–64 group are more likely to receive total hip arthroplasty than internal fixation for femoral neck fracture. Abstract: Introduction: Young patients with femoral neck fractures are optimally treated with reduction and stable fixation, while patients over the age of sixty-five are often treated with arthroplasty. This study analyzes in-hospital outcomes associated with total hip arthroplasty, hip hemiarthroplasty and internal fixation for treatment of femoral neck fractures in patients aged 45–64. Methods: Records of patients between the ages of 45–64, from 2002 to 2014, sustaining femoral neck fractures and treated with internal fixation, hip hemiarthroplasty or total hip arthroplasty were obtained from the Nationwide Inpatient Sample (NIS). Examined variables were age, sex and Charlson Comorbidity Index (CCI). Outcome measures included hospital length of stay (LOS), complications, and inpatient hospitalization charge. Results: From 2002–2014 74, 678 femoral neck fractures were available for analysis. THA use increased from 5.3% of operatively managed fractures in 2002 to 22.3% of operatively managed fractures in 2014 (p < 0.0001). Patients undergoing THA had higher hospital cost, higher in hospital complication rates and longer length of stay than patients undergoing internal fixation (p < 0.0001). The in-hospital mortality for patients undergoing a hip hemiarthroplasty was higher (1.2%) than either total hip arthroplasty (0.2%) or internal fixation (0.5%) (P = 0.007). Conclusion: This study demonstrates that the use of total hip arthroplasty in treatment of femoral neck fractures in patients from the age of 45–64 increased 4.2-fold over the study period. This treatment is associated with increased hospital cost, length of stay and complications. Additionally, as age increased in our study population, there was a stepwise increase in the use of arthroplasty, and it appears that hemiarthroplasty is being used with a different patient population.