Valgus Impacted Femoral Neck Fractures: Surgery or Non-Operative Approach?

Arvin Najafi; Mohsen Tavakoli; Danoosh Zargar; Dorsa Hadavi; Ehsan Seif; Salman Azarsina

doi:10.18502/jost.v7i2.6998

Valgus Impacted Femoral Neck Fractures: Surgery or Non-Operative Approach?

Abstract

Background: Non-operative management of valgus impacted femoral neck fracture leads to prolonged bed rest which may lead to deep vein thrombosis. The preferred method is the internal fixation because of pain control, enhanced mobilization, and better fracture healing but fails in older patients and individuals with medical comorbidities. The present study aims to assess the functional outcomes after the internal fixation or the non-operative management.

Methods: A retrospective cohort study was conducted at a Level I trauma center from January 2013 to December 2019 on all patients with valgus-impacted femoral neck fractures [Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association Classification (AO/OTA 31-B1)]. Overall, 81 patients were managed operatively with three partially threaded, cannulated screws in a parallel configuration and 21 patients were managed non operatively with instant mobilization, physical therapy, and partial weight-bearing protocol.

Results: 6 (28.0%) patients in the non-operative group and 3 (4.0%) cases in the operative group experienced fracture displacement (P < 0.001). 48 (59.2%) patients of the operative treatment group returned to baseline ambulatory function at 3 months, while this figure was 43.0% in the non-operative treatment group, not significantly different (P = 0.100). There was no significant difference in the mortality rates at one month and three months between the two groups (2 patients in each group, P = 0.140).

Conclusion: The ideal treatment of valgus-impacted femoral neck fractures is still controversial. The main purpose in the treatment of hip fractures is to return the patient to functional level equal to the level he or she was before the fracture. Surgically treated patients had lower failure rates in comparison with the other group.

1. Rockwood PR, Horne JG, Cryer C. Hip fractures: a future epidemic? Journal of orthopaedic trauma. 1990;4(4):388-93.
2. Praemer A, Furner S, Rice DP, Kelsey JL. Musculoskeletal conditions in the United States. 1999.
3. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. The Journal of bone and joint surgery American volume. 1994;76(1):15-25.
4. Nauth A, Creek A, Zellar A, Lawendy A, Dowrick A, Gupta A, et al. Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet. 2017;389:1519-27.
5. Kim Y-C, Lee J-Y, Song J-H, Oh S. The result of in situ pinning for valgus impacted femoral neck fractures of patients over 70 years old. Hip & pelvis. 2014;26(4):263.
6. Sikand M, Wenn R, Moran C. Mortality following surgery for undisplaced intracapsular hip fractures. Injury. 2004;35(10):1015-9.
7. Clement N, Green K, Murray N, Duckworth A, McQueen M. Undisplaced intracapsular hip fractures in the elderly: predicting fixation failure and mortality. A prospective study of 162 patients. Journal of Orthopaedic Science. 2013;18(4):578-85.
8. Lapidus LJ, Charalampidis A, Rundgren J, Enocson A. Internal fixation of garden I and II femoral neck fractures: posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years. Journal of orthopaedic trauma. 2013;27(7):386-90.
9. Palm H, Gosvig K, Krasheninnikoff M, Jacobsen S, Gebuhr P. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year. Acta orthopaedica. 2009;80(3):303-7.
10. Bjørgul K, Reikerås O. Outcome of undisplaced and moderately displaced femoral neck fractures: A prospective study of 466 patients treated by internal fixation. Acta orthopaedica. 2007;78(4):498-504.
11. Murphy DK, Randell T, Brennan KL, Probe RA, Brennan ML. Treatment and displacement affect the reoperation rate for femoral neck fracture. Clinical Orthopaedics and Related Research®. 2013;471(8):2691-702.
12. Kain MS, Marcantonio AJ, Iorio R. Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients. Clinical Orthopaedics and Related Research®. 2014;472(12):4010-4.
13. Chen W-C, Yu S-W, Tseng I-C, Su J-Y, Tu Y-K, Chen W-J. Treatment of undisplaced femoral neck fractures in the elderly. Journal of Trauma and Acute Care Surgery. 2005;58(5):1035-9.
14. Conn KS, Parker MJ. Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients. Clinical Orthopaedics and Related Research (1976-2007). 2004;421:249-54.
15. Garden RS. Low-angle fixation in fractures of the femoral neck. The Journal of Bone and Joint Surgery British volume. 1961;43(4):647-63.
16. Hui A, Anderson G, Choudhry R, Boyle J, Gregg P. Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians. The Journal of bone and joint surgery British volume. 1994;76(6):891-4.
17. Buord J-M, Flecher X, Parratte S, Boyer L, Aubaniac J-M, Argenson J-N. Garden I femoral neck fractures in patients 65 years old and older: is conservative functional treatment a viable option? Orthopaedics & Traumatology: Surgery & Research. 2010;96(3):228-34.
18. Cserhati P, Kazár G, Manninger J, Fekete K, Frenyo S. Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases. Injury. 1996;27(8):583-8.
19. Xu D-F, Bi F-G, Ma C-Y, Wen Z-F, Cai X-Z. A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. Journal of orthopaedic surgery and research. 2017;12(1):1-12.
20. Iorio R, Healy WL, Lemos DW, Appleby D, Lucchesi CA, Saleh KJ. Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. Clinical Orthopaedics and Related Research (1976-2007). 2001;383:229-42.
21. Lee BP, Berry DJ, Harmsen WS, Sim FH. Total hip arthroplasty for the treatment of an acute fracture of the femoral neck. Long-term results. JBJS. 1998;80(1):70-5.
22. March LM, Brnabic AJ, Chamberlain AC, Schwarz JM, Cameron ID, Cumming RG, et al. How best to fix a broken hip. Medical journal of Australia. 1999;170(10):489-94.
23. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium—2018. Journal of orthopaedic trauma. 2018;32:S1-S10.
24. Raaymakers E, Marti R. Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases. The Journal of bone and joint surgery British volume. 1991;73(6):950-4.
25. Shuqiang M, Kunzheng W, Zhichao T, Mingyu Z, Wei W. Outcome of non-operative management in Garden I femoral neck fractures. Injury. 2006;37(10):974-8.
26. Verheyen CC, Smulders TC, van Walsum AD. High secondary displacement rate in the conservative treatment of impacted femoral neck fractures in 105 patients. Archives of orthopaedic and trauma surgery. 2005;125(3):166-8.
27. Dolatowski FC, Frihagen F, Bartels S, Opland V, Benth JŠ, Talsnes O, et al. Screw fixation versus hemiarthroplasty for nondisplaced femoral neck fractures in elderly patients: a multicenter randomized controlled trial. JBJS. 2019;101(2):136-44.
28. Gordon M. Restoring functional independence in the older hip fracture patient. Geriatrics (Basel, Switzerland). 1989;44(12):48-53, 6, 9.
29. Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fracture in the elderly. Clinical orthopaedics and related research. 1998(348):22-8.
30. Craik RL. Disability following hip fracture. Physical Therapy. 1994;74(5):387-98.
31. Michel J-P, Hoffmeyer P, Klopfenstein C, Bruchez M, Grab B, d'Epinay CL. Prognosis of functional recovery 1 year after hip fracture: typical patient profiles through cluster analysis. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2000;55(9):M508-M15.
32. Tinetti ME, Baker DL, Gottschalk M, Williams CS, Pollack D, Garrett P, et al. Home-based multicomponent rehabilitation program for older persons after hip fracture: a randomized trial. Archives of physical medicine and rehabilitation. 1999;80(8):916-22.
33. Tolo E, Bostrom M, Simic P, Lyden J, Cornell C, Thorngren K-G. The short term outcome of elderly patients with hip fractures. International orthopaedics. 1999;23(5):279-82.

Files	XML PDF (424KB)
Issue	Vol 7, No 2 (2021)
Section	Research Articles
DOI	https://doi.org/10.18502/jost.v7i2.6998
Keywords
Femoral Neck Fractures; Femoral Fractures; Surgical Procedures

Rights and permissions
	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

How to Cite

Najafi A, Tavakoli M, Zargar D, Hadavi D, Seif E, Azarsina S. Valgus Impacted Femoral Neck Fractures: Surgery or Non-Operative Approach?. J Orthop Spine Trauma. 2021;7(2):39-43.

Vancouver

Download Citation