Young Intertrochanteric Femur Fractures are Associated with Fewer Complications than Young Femoral Neck Fractures.

OBJECTIVE To compare the complication profile of femoral neck (FN) and intertrochanteric (IT) femur fractures in young patients. DESIGN Retrospective Database Review SETTING:: Large, national private insurer claims database with longitudinal follow-up PATIENTS:: Individuals undergoing surgical fixation of IT or FN fractures from 2010-2017 were identified. Patients were included if they were 18-50 years of age and had 1-year postoperative follow-up. Those with comorbid conditions of chronic kidney disease (CKD), congestive heart failure (CHF), diabetes, or coronary artery disease (CAD) were excluded from the primary analysis. MAIN OUTCOME MEASURES Complication data, including a diagnosis of nonunion, malunion, avascular necrosis (AVN) or need for revision surgery at 1-year follow-up were compared. Additionally, medical complication data at 90-days post-operatively was evaluated. RESULTS In total, 808 patients were identified: 392 (48.5%) patients with IT femur fractures and 416 (51.5%) patients with FN fractures. On multivariate analysis, FN fractures had nearly twice the risk of nonunion compared to IT femur fractures (OR=1.89; CI 1.09-3.30). Intertrochanteric femur fractures had a 5.4% rate of nonunion, a 3.6% rate of revision surgery, a 1% rate of avascular necrosis (AVN), and a 0.8% rate of conversion into total hip arthroplasty (THA). In contrast, FN fractures had significantly higher rates of nonunion (10.3%; p=0.009), revision surgery (9.4%; p=0.001), AVN (5.8%; p<0.001) and conversion to THA (6%; p<0.001). CONCLUSION The results of this study demonstrate that IT fractures in young patients have superior outcomes when compared to their intracapsular counterparts. This is the only series of its kind to evaluate the complication profile of young IT femur fractures on a large scale. This information will be helpful in counseling patients in the peri-operative setting. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.