Prediction of Reoperation of Femoral Neck Fractures Treated With Cannulated Screws in Elderly Patients

Abstract

Background: Reoperation of femoral neck fractures in elderly patients is frequent. Our aim was to determine predictors of reoperations following primary internal fixation with 3 cannulated screws. Materials and Methods: A follow-up study included all patients aged 65+ years old patients consecutively admitted to an orthopedic ward with femoral neck fracture in the period from January 1, 2007, to December 31, 2010, and fixed with cannulated screws. We retrospectively obtained all available data from patient databases related to potential predictors of reoperations: gender, age, dwelling, dementia, body mass index, vitamin D, albumin, prednisolone treatment, walking aid, performance of activities of daily living, low-energy trauma, initial displacement, and surgery quality. Outcome was reoperation due to fixation failure/prominent screws, nonunion, or avascular necrosis of femoral head within 2 years after surgery. By multivariate Cox proportional hazards regression, including mortality as a competing risk, we estimated crude and adjusted hazards ratios (HRs) with 95% confidence intervals (CIs) for reoperation. Results: Two years after surgery, 29% of 322 elderly patients underwent reoperation. Reoperation was associated with primary fracture displacement (HR adjusted 1.61; 95% CI: 1.01-2.55; P = .04) compared to undisplacement. A poor quality of primary reduction was associated with a higher risk of reoperations than a good quality (HR adjusted 1.95; 95% CI: 1.02-3.72; P = .04). Elderly individuals in own homes and sheltered housings had a higher risk of reoperation (HR adjusted 2.67; 95% CI 1.35-5.31; P = .005) compared to nursing home residents. Conclusion: Our findings support the evidence of a higher incidence of reoperation in displaced femoral neck fractures compared to the nondisplaced and is associated with poor quality of fracture reduction. Reoperations are most frequent in younger and more independent patients living at home.