Internal fixation versus hemiarthroplasty for valgus impacted femoral neck fractures: Results from an institutional ortho-geriatric hip fracture registry.

Abstract

The ideal surgical treatment type for valgus impacted Garden I (AO 31B1.1) femoral neck fractures (FNFs) remains controversial. The primary aim of this study was to compare functional outcomes, mortality and reoperation rates between valgus impacted FNF patients treated with internal fixation (IF) or hemiarthroplasty (HA). The secondary outcomes studied were length of acute hospital stay, and postoperative medical complications. A retrospective cohort study was performed in a single level I trauma center. All patients aged 60 years and above who were treated surgically for valgus impacted Garden I (AO 31B1.1) femoral neck fractures between January 2014 and December 2021 were included. Case matching based on gender, age, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI) score and MBI score was performed. 208 patients (IF n = 104, HA n = 104) were included in the final study group. The IF group showed better mobility at six months compared to the HA group (31.4 % independent without aid vs 17.1 %, p-value = 0.047). However, at 12 months, this difference was no longer present (39.8 % independent without aid vs 34.4 %, p-value = 0.915). The HA group had higher rates of acute urinary retention compared to the IF group (37.5 % vs 24.0 %, p = 0.049). There was no statistically significant difference in MBI scores, reoperation rate, mortality rate, or length of hospital stay between the two groups. Internal fixation showed better mobility at the 6 month mark and lower postoperative urinary retention rates, with similar reoperation and mortality rates compared to hemiarthroplasty in the treatment of valgus-impacted femoral neck fractures.