Similar Demographic and Clinical Characteristics, but Different Surgical Outcomes in Displaced Femoral Neck Fractures and Intertrochanteric Hip Fractures in the Elderly

Background:
In the context of the increasing incidence of hip fractures and hip fracture surgery in the elderly, we hypothesized that the different surgical treatment strategies in distinct types of hip fractures result in different outcomes. This study compares patient characteristics and outcomes of displaced femoral neck fractures and intertrochanteric fractures treated with modern implants.

Methods:
A single-center cohort was retrospectively reviewed for all hip fracture cases treated surgically during 2016. We compared two groups of fractures and treatment: displaced femoral neck fractures treated with bipolar hemiarthroplasty and intertrochanteric fractures treated with an intramedullary nail or a sliding hip screw. Demographics, time to surgery, ASA score (American Society of Anesthesiologists Physical Status Classification System), surgical parameters, preoperative and postoperative radiographs, as well as primary (mortality, complications, and revision surgery) and secondary outcome variables were collected and analyzed. Bivariate analysis and Kaplan-Meier survival analysis were performed to evaluate outcomes.

Results:
Out of 398 cases, 368 (92.5%) met the inclusion criteria. The average follow-up time was 32.4 months (SD 3.62). Analysis of the fracture groups demonstrated similar demographic characteristics. Surgery time was significantly longer in the displaced femoral neck group (p<0.001). The intertrochanteric group required significantly more blood transfusion perioperatively (p=0.004). No significant differences were found in complications rates (p=0.836), postoperative ambulation (p=0.575), or length of stay and rehabilitation time (p=0.172, p=0.608 respectively). The 30-day, one-year, and two-year mortality rates were significantly higher in the displaced femoral neck group (p=0.034, p=0.002, p=0.018, respectively). Survival analysis showed a significantly higher mortality rate in the displaced femoral neck group (p=0.041).

Conclusion:
The current study demonstrates that though demographics and complication rates were similar, displaced femoral neck fractures in the elderly treated with hemiarthroplasty result in higher mortality rates versus intertrochanteric fractures treated with internal fixation devices.