title: Management of young femoral neck fractures: is there a consensus?
abstract: BACKGROUND
  Femoral neck fractures in young adults (ages <60) are high-energy injuries that are associated with major fracture healing complications such as avascular necrosis, nonunion, and significant shortening. Historically, evidence from small trials has suggested multiple cannulated screws were the optimal implant; however, newer studies and implant designs warrant reevaluation of screws as the gold standard among surgeons. In addition, controversies surrounding reduction technique and urgency of surgical fixation have been previously identified. We aimed to survey surgeon treatment preferences for these challenging fractures.
  
  
  METHODS
  A 17-item survey was developed and tested for validity and reliability prior to administration. The questionnaire characterised surgeon demographics, treatment preferences for displaced and undisplaced fractures, and controversies for future clinical trials. The target population consisted of surgeons from the Canadian Orthopaedic Association, the Orthopaedic Trauma Association, and attendees at an international fracture course.
  
  
  RESULTS
  540 surgeons completed the survey, exceeding our sample size requirement. There was a similar proportion of respondents from academic and community hospitals. Most surgeons (61%) treat 1-5 young adult femoral neck fractures per year. For undisplaced fractures, 78% of respondents prefer to use multiple cannulated screws. For displaced fractures, equal preference for multiple screws (46%) and the sliding hip screw (SHS, 49%) was reported. The majority of surgeons perform an open reduction in less than 25% of cases, and the time to fixation was typically between 8 and 24h.
  
  
  CONCLUSIONS
  Multiple cannulated screws remain the preferred treatment for most surgeons treating undisplaced fractures; however, there is an equal divide in preference between multiple screws and the SHS for displaced fractures. This increased preference for the SHS contradicts previous survey and small trial data recommending multiple screws for all fracture patterns. The lack of surgeon consensus and the high rates of fracture complications associated with fixation of young femoral neck fractures supports the need for definitive clinical trials to optimise patient important outcomes.
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, University of Toronto, Toronto, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: McKee
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: D000328:Adult; D001863:Bone Screws; D002170:Canada / Q000453:epidemiology; D032921:Consensus; D005060:Europe / Q000453:epidemiology; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005271:Femur Head Necrosis / Q000209:etiology / Q000517:prevention & control; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000209:etiology / Q000517:prevention & control; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: Femoral neck fracture; Non-geriatric hip fracture; Outcomes; Survey