TY - JOUR
T1 - Femoral Neck Fractures With Associated Ipsilateral Femoral Shaft Fractures in Young Adults <50 Years Old
T2 - A Multicenter Comparison of 80 Cases Versus Isolated Femoral Neck Fractures
AU - Rechter, Griffin R.
AU - Collinge, Cory A.
AU - Rechter, Alan J.
AU - Gardner, Michael J.
AU - Sagi, H. Claude
AU - Archdeacon, Michael T.
AU - Mir, Hassan R.
AU - Rodriguez-Buitrago, Andres
AU - Mitchell, Phillip
AU - Beltran, Michael T.
AU - Streufert, Ben
AU - Robinette, Patton
AU - O'neill, David
AU - Olszewski, Nathan
AU - Sems, Andrew
AU - Rainer, William
AU - Yuan, Brandon
AU - Jeray, Kyle
AU - Tanner, Stephanie
AU - Cardin Poza, Stefano
AU - Avilucea, Frank
AU - Schumaier, Adam
AU - Ketz, John
AU - Hedgecock, Jon
AU - Coles, Chad
AU - Trask, Kelly
AU - Macdonald, Shelley
AU - Scolaro, John
AU - Bustillo, David
AU - Crist, Brett D.
AU - Horner, Kevin
AU - Bergin, Patrick
AU - Miles, Daniel T.
AU - Spitler, Clay
AU - Ahn, Jaimo
AU - Bram, Joshua T.
AU - Morris, Tyler
AU - Hsu, Joseph
AU - Buck, J. Stewart
AU - Schmidt, Andrew
AU - Westberg, J. R.
AU - Tejwani, Nirmal
AU - Mehta, Devan
AU - Virkus, Walter
AU - Harrington, Justin
AU - Weber, Timothy
AU - Flint, Kathy
AU - Mullis, Brian
AU - Lancaster, Alex
AU - Liporace, Frank
AU - Adams, Don
AU - Horwitz, Daniel
AU - Yaacobi, Eyal
AU - Hymes, Robert
AU - Kilcoyne, Kelly
AU - Lusk, Dominic
N1 - Publisher Copyright:
Copyright © 2024 Wolters Kluwer Health, Inc.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - OBJECTIVES: To analyze patients, injury patterns, and treatment of femoral neck fractures (FNFs) in young patients with FNFs associated with shaft fractures (assocFNFs) to improve clinical outcomes. The secondary goal was to compare this injury pattern to that of young patients with isolated FNFs (isolFNFs). METHODS: Design: Retrospective multicenter cohort series. Setting: Twenty-six North American level-1 trauma centers. Patient Selection Criteria: Skeletally mature patients, ,50 years old, treated with operative fixation of an FNF with or without an associated femoral shaft fracture. Outcome Measures and Comparisons: The main outcome measurement was treatment failure defined as nonunion, malunion, avascular necrosis, or subsequent major revision surgery. Odds ratios for these modes of treatment were also calculated. RESULTS: Eighty assocFNFs and 412 isolFNFs evaluated in this study were different in terms of patients, injury patterns, and treatment strategy. Patients with assocFNFs were younger (33.3 6 8.6 vs. 37.5 6 8.7 years old, P , 0.001), greater in mean body mass index [BMI] (29.7 vs. 26.6, P , 0.001), and more frequently displaced (95% vs. 73%, P , 0.001), "vertically oriented"Pauwels type 3, P , 0.001 (84% vs. 43%) than for isolFNFs, with all P values , 0.001. AssocFNFs were more commonly repaired with an open reduction (74% vs. 46%, P , 0.001) and fixed-angle implants (59% vs. 39%) (P , 0.001). Importantly, treatment failures were less common for assocFNFs compared with isolFNFs (20% vs. 49%, P , 0.001) with lower rates of failed fixation/nonunion and malunion (P , 0.001 and P = 0.002, respectively). Odds of treatment failure [odds ratio (OR) = 0.270, 95% confidence interval (CI), 0.15-0.48, P , 0.001], nonunion (OR = 0.240, 95% CI, 0.10-0.57, P , 0.001), and malunion (OR = 0.920, 95% CI, 0.01-0.68, P = 0.002) were also lower for assocFNFs. Excellent or good reduction was achieved in 84.2% of assocFNFs reductions and 77.1% in isolFNFs (P = 0.052). AssocFNFs treated with fixed-angle devices performed very well, with only 13.0% failing treatment compared with 51.9% in isolFNFs treated with fixed-angle constructs (P = ,0.001) and 33.3% in assocFNFs treated with multiple cannulated screws (P = 0.034). This study also identified the so-called "shelf sign,"a transverse $6-mm medial-caudal segment of the neck fracture (forming an acute angle with the vertical fracture line) in 54% of assocFNFs and only 9% of isolFNFs (P , 0.001). AssocFNFs with a shelf sign failed in only 5 of 41 (12%) cases. CONCLUSIONS: AssocFNFs in young patients are characterized by different patient factors, injury patterns, and treatments, than for isolFNFs, and have a relatively better prognosis despite the need for confounding treatment for the associated femoral shaft injury. Treatment failures among assocFNFs repaired with a fixed-angle device occurred at a lower rate compared with isolFNFs treated with any construct type and assocFNFs treated with multiple cannulated screws. The radiographic "shelf sign"was found as a positive prognostic sign in more than half of assocFNFs and predicted a high rate of successful treatment.
AB - OBJECTIVES: To analyze patients, injury patterns, and treatment of femoral neck fractures (FNFs) in young patients with FNFs associated with shaft fractures (assocFNFs) to improve clinical outcomes. The secondary goal was to compare this injury pattern to that of young patients with isolated FNFs (isolFNFs). METHODS: Design: Retrospective multicenter cohort series. Setting: Twenty-six North American level-1 trauma centers. Patient Selection Criteria: Skeletally mature patients, ,50 years old, treated with operative fixation of an FNF with or without an associated femoral shaft fracture. Outcome Measures and Comparisons: The main outcome measurement was treatment failure defined as nonunion, malunion, avascular necrosis, or subsequent major revision surgery. Odds ratios for these modes of treatment were also calculated. RESULTS: Eighty assocFNFs and 412 isolFNFs evaluated in this study were different in terms of patients, injury patterns, and treatment strategy. Patients with assocFNFs were younger (33.3 6 8.6 vs. 37.5 6 8.7 years old, P , 0.001), greater in mean body mass index [BMI] (29.7 vs. 26.6, P , 0.001), and more frequently displaced (95% vs. 73%, P , 0.001), "vertically oriented"Pauwels type 3, P , 0.001 (84% vs. 43%) than for isolFNFs, with all P values , 0.001. AssocFNFs were more commonly repaired with an open reduction (74% vs. 46%, P , 0.001) and fixed-angle implants (59% vs. 39%) (P , 0.001). Importantly, treatment failures were less common for assocFNFs compared with isolFNFs (20% vs. 49%, P , 0.001) with lower rates of failed fixation/nonunion and malunion (P , 0.001 and P = 0.002, respectively). Odds of treatment failure [odds ratio (OR) = 0.270, 95% confidence interval (CI), 0.15-0.48, P , 0.001], nonunion (OR = 0.240, 95% CI, 0.10-0.57, P , 0.001), and malunion (OR = 0.920, 95% CI, 0.01-0.68, P = 0.002) were also lower for assocFNFs. Excellent or good reduction was achieved in 84.2% of assocFNFs reductions and 77.1% in isolFNFs (P = 0.052). AssocFNFs treated with fixed-angle devices performed very well, with only 13.0% failing treatment compared with 51.9% in isolFNFs treated with fixed-angle constructs (P = ,0.001) and 33.3% in assocFNFs treated with multiple cannulated screws (P = 0.034). This study also identified the so-called "shelf sign,"a transverse $6-mm medial-caudal segment of the neck fracture (forming an acute angle with the vertical fracture line) in 54% of assocFNFs and only 9% of isolFNFs (P , 0.001). AssocFNFs with a shelf sign failed in only 5 of 41 (12%) cases. CONCLUSIONS: AssocFNFs in young patients are characterized by different patient factors, injury patterns, and treatments, than for isolFNFs, and have a relatively better prognosis despite the need for confounding treatment for the associated femoral shaft injury. Treatment failures among assocFNFs repaired with a fixed-angle device occurred at a lower rate compared with isolFNFs treated with any construct type and assocFNFs treated with multiple cannulated screws. The radiographic "shelf sign"was found as a positive prognostic sign in more than half of assocFNFs and predicted a high rate of successful treatment.
KW - associated
KW - associated femoral neck fracture
KW - femoral neck fracture
KW - femoral neck fracture
KW - femoral neck-shaft fracture
KW - ipsilateral
KW - young
KW - young femoral neck fracture
UR - http://www.scopus.com/inward/record.url?scp=85199014703&partnerID=8YFLogxK
U2 - 10.1097/BOT.0000000000002826
DO - 10.1097/BOT.0000000000002826
M3 - Article
C2 - 39007656
AN - SCOPUS:85199014703
SN - 0890-5339
VL - 38
SP - 410
EP - 417
JO - Journal of Orthopaedic Trauma
JF - Journal of Orthopaedic Trauma
IS - 8
ER -