title: Complications following young femoral neck fractures.
abstract: BACKGROUND
  Femoral neck fractures in patients 60 years of age or younger are challenging injuries to treat because of the high-energy trauma mechanisms and the displaced fracture patterns typically found in this patient population. Understanding the burden of disease is an important first step in addressing treatment controversies in this population. The purpose of the current study is to quantitatively pool the incidence of patient important complications following internal fixation of young femoral neck fractures.
  
  
  METHODS
  A comprehensive search of the Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, and Central databases was completed under the direction of a biomedical librarian. Multiple outcomes of interest (complications) were collected and included: reoperation, femoral head avascular necrosis, fracture non-union, infection, implant failure, and malunion.
  
  
  RESULTS
  1558 fractures from 41 studies were included in the meta-analysis. An18.0% pooled reoperation incidence was observed for isolated femoral neck fractures. The total pooled incidence of avascular necrosis (AVN) was 14.3%, and the total incidence of nonunion was 9.3%. When stratified for fracture displacement displaced fractures were more likely to undergo reoperation and to result in AVN or non-union. The total incidence of malunion was 7.1%, implant failure was 9.7%, and surgical site infection was 5.1%. Complications associated with a femoral neck fracture treated in conjunction with an ipsilateral femoral shaft fracture were lower overall than the pooled estimates for isolated neck fractures.
  
  
  CONCLUSIONS
  The results of our analysis demonstrate that the incidence of complications experienced by young femoral neck fracture patients is relatively high. Reoperation following internal fixation of isolated femoral neck fractures occurred in nearly 20% of cases, and AVN and nonunion were the most common complications that likely contributed to repeat surgeries. These results highlight the importance of further efforts to improve the clinical outcomes in this population.
authors.affiliation: Department of Orthopaedic Surgery, University of British Columbia, Canada; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Canada. Electronic address: gsloboge@gmail.com.
authors.forename: G P
authors.initials: GP
authors.lastname: Slobogean
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Canada; Department of Clinical Epidemiology and Biostatics, McMaster University, Canada.
authors.forename: S A
authors.initials: SA
authors.lastname: Sprague
authors.affiliation: Department of Clinical Epidemiology and Biostatics, McMaster University, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Scott
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Canada; Department of Clinical Epidemiology and Biostatics, McMaster University, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000293:Adolescent; D000328:Adult; D005265:Femoral Neck Fractures / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005271:Femur Head Necrosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D005599:Fractures, Ununited / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Femoral neck fracture; Non-geriatiric hip fracture