HSS Journal - 2026-03-26 - Journal Article
Fixation of Basicervical Hip Fractures: Are Outcomes Distinct from Neighboring Valgus Neck and Intertrochanteric Fractures?
Hammond B, Fong C, Murugesan D, Ganta A, Konda S, Egol K
Topics
Key Takeaway
Basicervical hip fractures (AO/OTA 31B3) show comparable long-term outcomes to intertrochanteric and valgus femoral neck fractures but carry significantly higher rates of minor in-hospital complications even after multivariate adjustment, with no significant difference in outcomes across fixation constructs within the basicervical cohort.
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Summary
This retrospective review compared demographics, perioperative course, and outcomes among AO/OTA 31B3, 31A1.2, and 31B1.1 fractures treated with internal fixation across two urban trauma centers. BC patients were younger than IT patients and had higher ASA scores with more household ambulators than VFN patients; multivariate-adjusted analysis showed BC fractures had significantly more minor in-hospital complications than VFN fractures, with no differences in 30-day mortality, major complications, or long-term outcomes across groups. Within the BC cohort, no fixation construct demonstrated superior short- or long-term outcomes.
Key Limitation
Specific mean follow-up duration is not reported, making it impossible to assess whether long-term equivalence reflects true durability or insufficient observation time to detect late failures such as fixation cutout or avascular necrosis.
Original Abstract
BACKGROUND
Basicervical (BC) hip fractures represent a unique proximal femur fracture pattern for which the optimal treatment approach remains uncertain.
PURPOSE
We sought to evaluate demographic, perioperative, and outcome differences among patients with BC (31B3), intertrochanteric (IT; 31A1.2), and valgus femoral neck (VFN; 31B1.1) fractures treated with internal fixation.
METHODS
We conducted a retrospective review using prospectively collected data from October 2014 to March 2025 from a hip fracture database comprising 2 urban trauma centers. Patients with AO/OTA-classified 31B3, 31A1.2, or 31B1.1 fractures treated with non-arthroplasty fixation were included. Demographics, comorbidities, fracture characteristics, surgical constructs, and short- and long-term outcomes were compared. Multivariate regressions adjusted for baseline health and procedure type.
RESULTS
Of the 875 patients who met inclusion criteria, 122 had BC fractures, 523 had IT fractures, and 230 had VFN fractures. Patients with BC fractures were significantly younger than those with IT fractures; they had higher American Society of Anaesthesiologist scores and a greater proportion of household ambulators compared to those with VFN fractures, but were otherwise similar in comorbidity status. The BC cohort had significantly more minor in-hospital complications compared to the VFN cohort, even after multivariate adjustment. No significant differences were observed in 30-day mortality or major complications. Long-term outcomes were comparable across all groups. No significant differences in short- or long-term outcomes were observed across surgical constructs within the BC cohort.
CONCLUSION
Despite differing in baseline health status and surgical fixation strategies, BC fractures demonstrated comparable long-term outcomes to IT and VFN fractures. However, higher rates of minor complications in the BC group, even after adjustment, highlight a potentially greater perioperative risk. These findings suggest that while fixation may be effective long-term, further research is warranted to optimize acute management strategies for this anatomically and clinically distinct fracture pattern.
LEVEL OF EVIDENCE
Level IV: Prognostic retrospective study.