Fort Worth Orthopedic Trauma Surgeons, Fort Worth, TX.
Texas Christian University School of Medicine, Fort Worth, TX.
J Orthop Trauma. 2024 Aug 1;38(8):418-425. doi: 10.1097/BOT.0000000000002840.
To study the results of displaced femoral neck fractures (FNFs) in adults less than 60 years of age by comparing patients, injury, treatment, and the characteristics of treatment failure specifically according to patients' age at injury, that is, by their "decade of life" [ie, "under 30" (29 years and younger), "the 30s" (30-39 years), "the 40s" (40-49 years), and "the 50s" (50-59 years)].
Multicenter retrospective comparative cohort series.
Twenty-six North American Level 1 Trauma Centers.
Skeletally mature patients aged 18-59 years with operative repair of displaced FNFs.
Main outcome measures were treatment failures (fixation failure and/or nonunion, osteonecrosis, malunion, and the need for subsequent major reconstructive surgery (arthroplasty or proximal femoral osteotomy). These were compared across decades of adult life through middle age (<30 years, 30-39 years, 40-49 years, and 50-59 years).
Overall, treatment failure was observed in 264 of 565 (47%) of all hips. The mean age was 42.2 years, 35.8% of patients were women, and the mean Pauwels angle was 53.8 degrees. Complications and the need for major secondary surgeries increased with each increasing decade of life assessed: 36% of failure occurred in patients <30 years of age, 40% in their 30s, 48% in their 40s, and 57% in their 50s (P < 0.001). Rates of osteonecrosis increased with decades of life (under 30s and 30s vs. 40s vs. 50s developed osteonecrosis in 10%, 10%, 20%, and 27% of hips, P < 0.001), while fixation failure and/or nonunion only increased by decade of life to a level of trend (P = 0.06). Reparative methods varied widely between decade-long age groups, including reduction type (open vs. closed, P < 0.001), reduction quality (P = 0.030), and construct type (cannulated screws vs. fixed angle devices, P = 0.024), while some variables evaluated did not change with age group.
Displaced FNFs in young and middle-aged adults are a challenging clinical problem with a high rate of treatment failure. Major complications and the need for complex reconstructive surgery increased greatly by decade of life with the patients in their sixth decade experiencing osteonecrosis at the highest rate seen among patients in the decades studied. Interestingly, treatments provided to patients in their 50s were notably different than those provided to younger patient groups.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
通过比较患者、损伤、治疗以及治疗失败的特征，尤其是根据患者受伤时的年龄（即“十年期”[即“30 岁以下”（29 岁及以下）、“30 年代”（30-39 岁）、“40 年代”（40-49 岁）和“50 年代”（50-59 岁）]，研究 60 岁以下成人移位股骨颈骨折（FNF）的结果。
多中心回顾性比较队列研究。
26 家北美一级创伤中心。
骨骼成熟、年龄 18-59 岁、接受移位 FNF 手术修复的患者。
主要结局指标是治疗失败（固定失败和/或不愈合、骨坏死、畸形愈合以及需要后续主要重建手术（关节置换或股骨近端截骨术）。通过中年（<30 岁、30-39 岁、40-49 岁和 50-59 岁）各个“十年期”，比较所有髋关节中所有治疗失败（固定失败和/或不愈合、骨坏死、畸形愈合和需要后续主要重建手术（关节置换或股骨近端截骨术）。
565 例髋关节中，264 例（47%）发生治疗失败。平均年龄为 42.2 岁，35.8%的患者为女性，平均 Pauwels 角为 53.8 度。并发症和需要主要二次手术的概率随着评估的年龄每增加十年而增加：<30 岁的患者中有 36%发生失败，30 多岁的患者中有 40%，40 多岁的患者中有 48%，50 多岁的患者中有 57%（P<0.001）。骨坏死的发生率随年龄的增长而增加（<30 岁和 30 多岁的患者发生骨坏死的比例为 10%、10%、20%和 27%，P<0.001），而固定失败和/或不愈合仅随年龄呈趋势增加（P=0.06）。各年龄段之间修复方法差异很大，包括复位类型（开放与闭合，P<0.001）、复位质量（P=0.030）和固定类型（空心钉与固定角度装置，P=0.024），而一些评估的变量并未随年龄组而改变。
年轻和中年成人移位股骨颈骨折是一个具有挑战性的临床问题，治疗失败率很高。主要并发症和对复杂重建手术的需求随着年龄的增长而显著增加，60 岁以上患者的骨坏死发生率最高。有趣的是，50 多岁患者接受的治疗明显不同于年轻患者群体。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
