Risk assessment of femoral head AVN following reduction and fixation of intracapsular hip fractures in patients younger than 65 years over a 10 year follow up.
Level 4 - case-series / case-control
Retrospective single-center observational study
PubMed 39962325 · doi:10.1038/s41598-025-89974-2
What was done
A single-center retrospective study evaluated 160 patients younger than 65 years (mean age 50 ± 12 years; 78 males) who underwent reduction and internal fixation for intracapsular hip fractures. Fracture classifications included Garden 1 (n=67), Garden 2 (n=33), Garden 3 (n=42), and Garden 4 (n=19). Surgical fixations were Cannulated Hip Screws (n=75), Femoral Neck System (n=69), and Dynamic Hip Screw (n=17). Patients were followed for an average of 10 years (range: 1–14 years) to assess risk factors associated with conversion to total hip replacement (THR) due to avascular necrosis (AVN).
What was found
THR conversion due to AVN occurred in 14 patients (8.7%) at a mean conversion age of 52.76 ± 15 years and a mean time to conversion of 22.2 months (range: 2–132 months). Univariate analysis identified fracture displacement (Garden 3–4), gender, smoking status, and diabetes mellitus as significant predictors of conversion; surgical method showed a trend (p = 0.08). In multivariate logistic regression, a model combining fracture displacement, gender, and smoking status accounted for 45% of the variance in THR conversion (p < 0.01; odds ratios and confidence intervals were not reported in the abstract).
Why it matters
It defines long-term joint-preservation failure rates in patients under 65 with intracapsular hip fractures and highlights clinical factors like displacement and smoking that may guide initial management decisions.
Limits
The study is retrospective and from a single center. The number of conversion events is very low (n=14), raising concerns about model overfitting. Follow-up duration varied substantially (1 to 14 years), and specific effect sizes (odds ratios and confidence intervals) were not detailed in the abstract.
Cited by
- supports Disruption of blood supply following a femoral neck fracture leads to avascular necrosis necessitating a total hip replacement.