Abstract
Aim: To assess the aetiology, management and early outcome of young patients presenting with an intracapsular hip fracture. Unlike older patients, this population is much more likely to be considered for femoral head conservation by means of internal fixation, regardless of fracture displacement.
Methods: A prospectively-collected trauma database was used to identify patients under 65 years-old presenting to a teaching hospital with an intracapsular hip fracture between 1998 and 2002. Thereafter full case note and radiological review was performed using a standardised data-extraction form.
Results: Of 2031 patients presenting with hip fractures, 282 were under 65 years-old; 139 had intracapsular fractures. Complete records were available for 89 patients (45 male, 44 female). Mean ages were 55.6 (males) and 58.2 years (females). These injuries were almost exclusively low-energy injuries (90%). 83% were displaced fractures. 39% had evidence of chronic alcohol-abuse; these were predominantly males (76% of alcohol-abusers). Excluding alcohol-abuse, 53% of all patients had major co-morbidity such as severe cardiovascular, respiratory, neurological or systemic disorders. There were similar rates for males and females (53% versus 52%). Including alcohol-abuse, 69% of patients had major co-morbidity.
Treatment modalities included internal fixation (80%; 76% of displaced fractures), hemiarthroplasty (17%) and total hip replacement (3%).
Follow-up was for a mean 3.67 years (range 0.01–5.96 years). Three patients died (3.4%). Of the displaced fractures treated with fixation, five patients developed avascular necrosis (8.9%); two of these were managed conservatively. Seven patients (12.5%) required a total of nine revision procedures. No failures occurred in other initial treatment modalities or undisplaced fractures. There was no significant relationship between pre-operative duration and subsequent avascular necrosis or need for revision surgery.
Conclusions: As with older populations, these are generally low-energy injuries associated with significant co-morbidity, notably chronic alcohol-abuse. Despite this, mortality remains very low. Only 12.5% of patients undergoing internal fixation of displaced intracapsular fractures required revision surgery over a 3.7 year mean follow-up; thus this is an acceptable method of treatment for such injuries in this group of patients.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
