title: Treatment and displacement affect the reoperation rate for femoral neck fracture.
abstract: BACKGROUND
  Femoral neck fractures (FNFs) comprise 50% of geriatric hip fractures. Appropriate management requires surgeons to balance potential risks and associated healthcare costs with surgical treatment. Treatment complications can lead to reoperation resulting in increased patient risks and costs. Understanding etiologies of treatment failure and the population at risk may decrease reoperation rates.
  
  
  OBJECTIVE
  We therefore (1) determined if treatment modality and/or displacement affected reoperation rates after FNF; and (2) identified factors associated with increased reoperation and timing and reasons for reoperation.
  
  
  METHODS
  We reviewed 1411 records of patients older than 60 years treated for FNF with internal fixation or hemiarthroplasty between 1998 and 2009. We extracted patient age, sex, fracture classification, treatment modality and date, occurrence of and reasons for reoperation, comorbid conditions at the time of each surgery, and dates of death or last contact. Minimum followup was 12 months (median, 45 months; range, 12-157 months).
  
  
  RESULTS
  Internal fixation (hazard ratio [HR], 6.38) and displacement (HR, 2.92) were independently associated with increased reoperation rates. The reoperation rate for nondisplaced fractures treated with fixation was 15% and for displaced fractures 38% after fixation and 7% after hemiarthroplasty. Most fractures treated with fixation underwent reoperation within 1 year primarily for nonunion. Most fractures treated with hemiarthroplasty underwent reoperation within 3 months, primarily for infection.
  
  
  CONCLUSIONS
  Overall, hemiarthroplasty resulted in fewer reoperations versus internal fixation and displaced fractures underwent reoperation more than nondisplaced. Our data suggest there are fewer reoperations when treating elderly patients with displaced FNFs with hemiarthroplasty than with internal fixation.
authors: Department of Orthopaedics, Scott & White HealthCare/Texas A&M Health Science Center, 2401 South 31st Street, Temple, TX 76508, USA. dmurphy@sw.org
authors: Donavan K
authors: DK
authors: Murphy
authors: Timmothy
authors: T
authors: Randell
authors: Kindyle L
authors: KL
authors: Brennan
authors: Robert A
authors: RA
authors: Probe
authors: Michael L
authors: ML
authors: Brennan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000175:diagnosis / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D062785:Hemiarthroplasty / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
references: J Bone Joint Surg Am. 2012 Mar 7;94(5):418-25
references: 22398735
references: Acta Orthop Scand. 2003 Feb;74(1):42-4
references: 12635791
references: Nord Med. 1985;100(10):256-9
references: 3913899
references: J Am Acad Orthop Surg. 2008 Oct;16(10):596-607
references: 18832603
references: Clin Orthop Relat Res. 2001 Feb;(383):229-42
references: 11210960
references: J Bone Joint Surg Br. 2007 Feb;89(2):160-5
references: 17322427
references: J Bone Joint Surg Br. 2002 Nov;84(8):1150-5
references: 12463661
references: J Bone Joint Surg Br. 2001 Mar;83(2):206-12
references: 11284567
references: J Bone Joint Surg Am. 2005 Aug;87(8):1680-8
references: 16085605
references: J Bone Joint Surg Br. 2005 Apr;87(4):523-9
references: 15795204
references: J Bone Joint Surg Am. 2006 Dec;88(12):2583-9
references: 17142407
references: J Trauma. 2005 May;58(5):1035-9; discussion 1039
references: 15920421
references: J Bone Joint Surg Br. 2003 Apr;85(3):380-8
references: 12729114
references: J Orthop Trauma. 1999 Mar-Apr;13(3):155-9
references: 10206245
references: Clin Orthop Relat Res. 2004 Apr;(421):249-54
references: 15123955
references: J Orthop Trauma. 2007 Nov-Dec;21(10 Suppl):S1-133
references: 18277234
references: Clin Orthop Relat Res. 1987 May;(218):58-62
references: 3568496
references: J Bone Joint Surg Br. 1976 Feb;58(1):2-24
references: 1270491
references: Acta Orthop. 2011 Jun;82(3):268-74
references: 21619501
references: Bone. 1996 Jan;18(1 Suppl):57S-63S
references: 8717549
references: Clin Orthop Relat Res. 2008 Dec;466(12):3116-22
references: 18648899
references: Injury. 2009 Mar;40(3):274-6
references: 19070851
references: J Orthop Trauma. 2002 Jan;16(1):34-8
references: 11782631
references: J Orthop Trauma. 2009 Jul;23(6):442-6
references: 19550232
references: Clin Orthop Relat Res. 2012 Jun;470(6):1782-91
references: 22278852
references: Acta Orthop. 2006 Jun;77(3):368-74
references: 16819673
references: J Bone Joint Surg Am. 2010 Mar;92(3):619-28
references: 20194320
references: Arch Orthop Trauma Surg. 1993;113(1):39-45
references: 8117509
references: Injury. 2000 Dec;31(10):793-7
references: 11154750
references: Injury. 1989 Nov;20(6):368-70
references: 2628338
references: Injury. 2010 Apr;41(4):370-3
references: 19879576
references: Arch Orthop Trauma Surg. 1996;115(2):90-3
references: 9063859
references: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001708
references: 17054139
references: J Bone Joint Surg Br. 2002 Mar;84(2):183-8
references: 11922358
references: Ann Chir Gynaecol. 2000;89(2):132-7
references: 10905680
references: J Bone Joint Surg Br. 1994 Nov;76(6):891-4
references: 7983113
references: Acta Orthop Scand. 1998 Aug;69(4):387-91
references: 9798447
references: J Bone Joint Surg Am. 2003 Sep;85(9):1673-81
references: 12954824
references: J Bone Joint Surg Br. 1988 Aug;70(4):588-90
references: 3403602
references: BMJ. 2007 Dec 15;335(7632):1251-4
references: 18056740
references: J Am Acad Orthop Surg. 2006 Sep;14(9):565-71
references: 16959894
references: Ann Chir Gynaecol. 2001;90(3):225-8
references: 11695801
references: Clin Orthop Relat Res. 2002 Oct;(403):118-26
references: 12360017
references: Injury. 1988 Mar;19(2):93-6
references: 3198273
references: J Orthop Trauma. 2009 Jul;23(6):471-8
references: 19550237
references: Acta Orthop. 2007 Aug;78(4):498-504
references: 17966004
references: Injury. 1993 Apr;24(4):241-2
references: 8325680
references: Clin Orthop Relat Res. 2002 Jun;(399):110-8
references: 12011699
references: J Am Acad Orthop Surg. 2005 Mar-Apr;13(2):101-9
references: 15850367
references: Arch Orthop Trauma Surg. 2005 Sep;125(7):503-5
references: 16075274
references: J Bone Joint Surg Am. 1994 Jan;76(1):15-25
references: 8288658
references: Acta Orthop Traumatol Turc. 2006;40(4):291-300
references: 17063052
references: Br J Surg. 1979 Jan;66(1):56-60
references: 369644