Department of Orthopedic Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, 528000, China.
Department of Orthopedic Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, 528000, China; The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong, 528000, China.
Injury. 2024 Oct;55(10):111690. doi: 10.1016/j.injury.2024.111690. Epub 2024 Jul 6.
Femoral neck fractures (FNF) in young and middle-aged adults are primarily caused by high-energy injuries in traffic accidents. Surgical delays often occur due to transportation issues, preoperative evaluations, and economic burdens.
A retrospective analysis was conducted on young and middle-aged FNF patients undergoing reduction and internal fixation surgeries from 2010 to 2019 with the use of the National Inpatient Sample database. Logistic regression analysis was used to assess the relationship between surgical delays and complications, and the independent risk factors contributing to delays. Categorical variables were investigated via a chi-square test, while continuous variables including Elixhauser Comorbidity Index (ECI) scores, length of hospital stay (LOS), and total medical costs were analyzed via t-test or rank-sum test.
9,204 patients undergoing reduction and internal fixation surgeries were included. In the delayed group, patients had higher ECI scores, longer hospital stays, higher expenses, and increased inpatient mortality (1.61% vs. 0.28 %, P < 0.0001). Longer surgical delays were associated with higher risks of complications, including femoral head osteonecrosis, internal fixation loosening and breakage, and respiratory complications. Fluid and electrolyte disorders, metastatic cancer, pulmonary circulation disorders, and renal failure were identified as independent risk factors for surgical delays. Except for anemia (OR=2.37, P < 0.0001), no significant differences in early postoperative complications were found between open-reduction and closed-reduction internal fixation (ORIF/CRIF) surgeries.
Early surgical intervention, within a 2-days period after injury, seems to be crucial for young adults with FNF. If CRIF is challenging in some cases, ORIF can be another choice.
中青年股骨颈骨折（FNF）主要由交通伤中的高能损伤引起。由于交通问题、术前评估和经济负担，手术常被延迟。
回顾性分析了 2010 年至 2019 年期间使用国家住院患者样本数据库接受复位内固定手术的中青年 FNF 患者。使用逻辑回归分析评估手术延迟与并发症之间的关系，以及导致延迟的独立危险因素。使用卡方检验分析分类变量，使用 t 检验或秩和检验分析连续变量，包括 Elixhauser 合并症指数（ECI）评分、住院时间（LOS）和总医疗费用。
共纳入 9204 例行复位内固定手术的患者。在延迟组中，患者的 ECI 评分较高，住院时间较长，费用较高，住院病死率较高（1.61%比 0.28%，P<0.0001）。手术延迟时间越长，并发症的风险越高，包括股骨头坏死、内固定松动和断裂以及呼吸系统并发症。液体和电解质紊乱、转移性癌症、肺循环障碍和肾衰竭被确定为手术延迟的独立危险因素。除贫血（OR=2.37，P<0.0001）外，切开复位内固定术（ORIF）与闭合复位内固定术（CRIF）之间早期术后并发症无显著差异。
对于中青年 FNF 患者，伤后 2 天内进行早期手术干预似乎至关重要。如果 CRIF 在某些情况下有困难，ORIF 可以作为另一种选择。
