Short-to Medium-term Results of Displaced Femoral Neck Fractures in Patients Less than 50 Years of Age Undergoing Repair: Comparison of Open vs. Closed Reduction.

OBJECTIVES: To compare the clinical outcomes of open vs. closed reduction methods for femoral neck fractures (FNFs) in young patients treated with fracture repair.

METHODS: Design: Multicenter retrospective cohort study.

SETTING: Twenty-six North American Level 1 trauma centers.

PATIENT SELECTION CRITERIA: Skeletally mature patients aged <50 years with displaced FNFs (OTA/AO type 31B) undergoing surgical repair and having minimum follow-up >6 months, except in cases where major complications occurred earlier.

INTERVENTION: Open vs. closed fracture reduction.

MAIN OUTCOME MEASUREMENTS: The primary outcome of "major complication" was defined as nonunion/failed fixation, osteonecrosis, malunion (vertical or femoral neck shortening of ≥15 mm) and/or subsequent major reconstructive surgery was compared by reduction method using chi-squared tests and risk-adjusted binary mixed effects regression models.

RESULTS: A total of 290 patients with FNFs were included in the study, 107 treated with closed reduction (average follow-up 27.1 months [range, 4.1 to 159.5 months]) and 183 treated with open reduction and (average follow-up 22.4 months [range, 3.7 to 141.3 months], P=0.105). Sex distribution showed no difference between the groups, with 25.5% of the closed group, and 29.0% of the open cohort being female (P=0.615). Patients who received open reduction were younger than patients who received closed reductions (mean age 35.6±8.8 vs. 39.5±8.0 years, P<0.001) and had fewer cases of cases of diabetes mellitus (2.2% vs. 8.6%, P=0.027). Overall, adverse events were observed following 57.0% of closed reduction reductions vs. 54.1% of open reductions (P=0.890). No differences were seen in the frequency of defined failure modes, including failed fixation/nonunion (33.6% closed vs. 35.0% open, P=0.919), osteonecrosis (21.5% closed vs. 14.2% open, P=0.151), malunion (17.8% closed vs. 14.8% open, P=0.611), or major reconstructive surgery (33.6% closed vs. 36.6% open, P=0.702).

CONCLUSIONS: Open and closed reductions of FNFs in patients <50 years old were associated with similar rates of repair failure.

LEVEL OF EVIDENCE: Level III (Therapeutic).