JOT - 2026-08-19 - Journal Article
Short-to Medium-term Results of Displaced Femoral Neck Fractures in Patients Less than 50 Years of Age Undergoing Repair: Comparison of Open vs. Closed Reduction.
Collinge C, Wong H, Patterson J, Finlay A, Gardner M, Lebus GF, Morshed S, Rodriguez-Buitrago A, Beltran MJ, Mitchell P, Will J, Ketz J, Tornetta P, and the Young Femoral Neck Working Group
Topics
Key Takeaway
Open versus closed reduction of displaced femoral neck fractures in patients under 50 yielded statistically equivalent major complication rates (57.0% vs. 54.1%) across 290 patients at mean follow-up of 22–27 months.
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Summary
This multicenter retrospective cohort across 26 North American Level 1 trauma centers compared open versus closed reduction for displaced femoral neck fractures (OTA/AO 31B) in skeletally mature patients under 50. The primary composite outcome—nonunion/failed fixation, osteonecrosis, malunion ≥15 mm, or major reconstructive surgery—did not differ between groups (57.0% closed vs. 54.1% open, P=0.890). Individual failure modes including failed fixation/nonunion (33.6% vs. 35.0%), osteonecrosis (21.5% vs. 14.2%), and conversion to major reconstructive surgery (33.6% vs. 36.6%) were all statistically equivalent.
Key Limitation
Retrospective design with non-randomized allocation means surgeons selected open reduction for cases deemed more difficult or poorly reducible closed, making the two groups inherently non-equivalent despite statistical adjustment.
Original Abstract
OBJECTIVES
To compare the clinical outcomes of open vs. closed reduction methods for femoral neck fractures (FNFs) in young patients treated with fracture repair.
METHODS
Design: Multicenter retrospective cohort study.
SETTING
Twenty-six North American Level 1 trauma centers.
PATIENT SELECTION CRITERIA
Skeletally mature patients aged <50 years with displaced FNFs (OTA/AO type 31B) undergoing surgical repair and having minimum follow-up >6 months, except in cases where major complications occurred earlier.
INTERVENTION
Open vs. closed fracture reduction.
MAIN OUTCOME MEASUREMENTS
The primary outcome of "major complication" was defined as nonunion/failed fixation, osteonecrosis, malunion (vertical or femoral neck shortening of ≥15 mm) and/or subsequent major reconstructive surgery was compared by reduction method using chi-squared tests and risk-adjusted binary mixed effects regression models.
RESULTS
A total of 290 patients with FNFs were included in the study, 107 treated with closed reduction (average follow-up 27.1 months [range, 4.1 to 159.5 months]) and 183 treated with open reduction and (average follow-up 22.4 months [range, 3.7 to 141.3 months], P=0.105). Sex distribution showed no difference between the groups, with 25.5% of the closed group, and 29.0% of the open cohort being female (P=0.615). Patients who received open reduction were younger than patients who received closed reductions (mean age 35.6±8.8 vs. 39.5±8.0 years, P<0.001) and had fewer cases of cases of diabetes mellitus (2.2% vs. 8.6%, P=0.027). Overall, adverse events were observed following 57.0% of closed reduction reductions vs. 54.1% of open reductions (P=0.890). No differences were seen in the frequency of defined failure modes, including failed fixation/nonunion (33.6% closed vs. 35.0% open, P=0.919), osteonecrosis (21.5% closed vs. 14.2% open, P=0.151), malunion (17.8% closed vs. 14.8% open, P=0.611), or major reconstructive surgery (33.6% closed vs. 36.6% open, P=0.702).
CONCLUSIONS
Open and closed reductions of FNFs in patients <50 years old were associated with similar rates of repair failure.
LEVEL OF EVIDENCE
Level III (Therapeutic).