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.

Aim: Alcohol-abuse is a well-recognised problem in the West of Scotland. This retrospective case-note study aims to assess the presentation, management and early outcome of alcohol-abusing patients sustaining displaced intracapsular fractures compared to age-matched controls.

Methods: Patients were identified from a prospectively-collected database of trauma admissions from 1998 to 2002. Alcohol-abuse was defined by documented evidence of excessive and chronic alcohol intake.

Results: 35 alcohol-abusing patients under the age of 65 (mean age 57.5 years) with displaced intracapsular fractures were identified and followed-up for a mean of 3.87 years, and compared with 39 age-matched controls (mean follow-up 3.35 years).

There was a significant difference between groups in interval between injury and surgery, with alcohol-abusers undergoing surgery 40.2 hours after injury compared to 22.2 hours for controls (p=0.039). Post-operative stay was also significantly different, with discharge at 7.0 and 5.0 days post-operatively for abusers and controls respectively (p=0.002). 26% of abusers required increased level of care after discharge compared with 15% of non-abusers, although this did not reach statistical significance.

Reduction and fixation was employed in 26 alcohol-abusing patients and 30 controls. Early postoperative complications were similar in both groups with the exception of delirium tremens (17% of abusers). Of patients treated with internal fixation, four patients in the alcohol-abuse group required revision surgery (15%) compared to three of the control group (10%, no significant difference). Two patients within the abusers group developed avascular necrosis (7.7%) compared to three within the control population (10%, no significant difference); only two of these five required revision surgery with femoral head replacement.

During the follow-up period, alcohol-abusers had a five-fold higher rate of subsequent fractures of their contralateral hip or elsewhere (p=0.02).

Conclusions: Alcohol-abusing patients with displaced intracapsular fractures have an increased economic burden compared to controls requiring longer inpatient stays and more frequent subsequent fractures. However, despite increased intervals between injury and surgery, this study finds no evidence that they are at greater risk of failure of internal fixation as compared to controls.