Abstract
Background: Intracapsular hip fractures in young adults under 50 years of age have a significant risk of fracture healing complications which has led some authors to advocate urgent fracture reduction and/or open reduction. As these fractures are infrequent, limited information is available from published studies to advocate a particular method of treatment to reduce the risk of complications. The purpose of this study is to analyze outcomes following such fractures with particular reference to the influence of the degree of fracture displacement, timing of surgery, method of reduction (open/closed) on the incidence of non-union and avascular necrosis.
Methods: Specific search terms were used to retrieve relevant studies from MEDLINE, EMBASE, and CINAHL extending from 1966 to May 2003. Guidelines for reporting of meta-analysis, adapted from QUOROM statement were followed.
Results: Eighteen studies with 564 fractures were identified for analysis. The overall incidence of non-union was 50/564 (8.9%) and avascular necrosis (AVN) was 130/564 (23.0%). There was a higher incidence of non-union and AVN following displaced than undisplaced fractures. Non-union occurred more frequently after open reduction than closed reduction (10/89 [11.2%] versus 13/275 [4.7%], P=0.04, RR=0.42, 95% CI: 0.19 to 0.93).
There was an increased incidence of AVN after closed than open reduction (P= 0.0005, RR = 2.77, 95% CI: 1.45 to 5.29) but this became not statistically significant when one study with a markedly higher reported incidence of AVN was excluded (P = 0.07, RR= 1.85, 95% CI: 0.93 to 3.68).
The difference in the incidence of non-union and AVN following early (< 12 hours) or late (> 12 hours) surgery was not significant for either non-union or AVN (13/110 [11.8%] versus 3/60 [5.0%], p=0.18, RR2.36, CI 0.70 to 7.97 for non-union, 15/110 [13.6%] versus 9/60 [15.0%], p=0.82, RR=0.91, CI 0.42 to 1.95 for AVN).
Conclusion: Early (< 12 hours) or open reduction of these fractures may not reduce the risk of non-union or avascular necrosis. There is a suggestion of a higher incidence of non-union following open reduction than closed reduction. Randomized studies or prospective observational studies with a minimum follow-up of two years are required to report on a larger number of patients in this age group before definite conclusions on treatment can be made.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
