Poor results of functional treatment of Garden-1 femoral neck fracture in dependent patients - 18/12/19

Doi : 10.1016/j.otsr.2019.09.027

Roger Erivan ^a,⁎ , Marion Soleihavoup ^b, Guillaume Villatte ^a, Daniel Perez Prieto ^c, Stéphane Descamps ^a, Stéphane Boisgard ^a
^a Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
^b Université Clermont-Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
^c ICATME, hospital, universitari Dexeus, Parc de Salut Mar, Barcelona, Spain

^⁎Corresponding author at: Orthopedic and trauma surgery department, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand, France.Orthopedic and trauma surgery department, hôpital Gabriel-Montpied, CHU de Clermont-FerrandBP 69Clermont-Ferrand63003France

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Abstract

Introduction

Variable results are reported after functional treatment for Garden-1 femoral neck fracture, with no definite factors for failure, particularly in the absence of selection for risk. It seems well indicated in frail and/or dependent patients with comorbidities, but this has not been specifically assessed, and failure is frequent in this target population. We therefore performed a retrospective study to: (1) assess results of functional treatment for Garden-1 impacted femoral neck fracture in dependent patients, and (2) analyze survival in terms of complications and death, and related factors.

Hypothesis

Functional treatment for Garden-1 fracture in dependent patients gives poor results, with a high rate of surgical revision.

Material and methods

A retrospective analysis was made of Garden-1 femoral neck fracture in dependent patients (Parker score≤5), with a minimum 2 years’ follow-up. One hundred and forty-six patients were included: mean age, 81.3±8.7 years (range, 55.7–99.6 years). The endpoint was survival in terms of complications requiring surgery, secondary displacement requiring surgery, excessive pain requiring surgery, non-union or femoral head osteonecrosis. Secondary endpoints were overall mortality and mortality related to complications.

Results

Mean follow-up was 4.2±2.6 years (range, 2.0–10.3 years). Ninety-one of the 146 patients (62.3%) required secondary surgery: 79 (54.1%) early (<3 months post-fracture), with 77 (52.7%) secondary displacements and 2 cases (1.4%) of excessive pain; and 12 (8.2%) late (162.2±132.3 days; range, 90–454 days), with 8 (5.4%) non-unions and 4 (2.7%) osteonecroses. Mean time to onset of secondary displacement was 13.6±11.8 days (range, 0–67.0 days). Two-year survival in terms of revision surgery was 34.1% [95% CI: 26.0–42.4]. At last follow-up, 91 patients (62.3%) had died; 2-year survival in terms of death was 69.9% [95% CI: 62.4–77.3]. Survival analysis in terms of complications revealed greater mortality in absence of complications: 42 of the 55 patients (76.3%) without complications requiring surgery died, versus 49 of the 91 (53.8%) with complications requiring surgery (p=0.012); relative risk of death in absence of complications requiring surgery was 1.42 [95% CI: 1.33–5.77].

Discussion

Functional treatment for Garden-1 fracture in dependent patients gave poor short- and medium-term results. Surgery is therefore recommended in this specific population; the present findings should improve survival.