Unsatisfactory Post-operative Imaging Is Predictive of Revision Surgery in Intracapsular Hip Fracture Fixation

Failed fixation of intracapsular hip fractures in young patients is associated with high morbidity and cost. Accordingly, we set out to determine the association between unsatisfactory post-operative imaging (judged by two fellowship-trained trauma consultants and a senior trainee) and the risk of subsequent reoperation, including adjustment for potential confounding variables. Ninety-four (94) patients aged <60 were included in the study from a single major trauma centre. Exhausted patients (19%) required further surgery, with the most common reason being avascular necrosis (n=10) followed by non-union (n=6). Univariate analysis found only smokers and unsatisfactory fracture reduction to be predictive of failure (p < 0.05). Other demographics and recognised scoring systems from the literature were poor predictors of failure apart from the Haiduewych classification system, utilised to assess the quality of reduction, which showed a trend towards significance (p0.053). Multivariate analysis showed smoking and unsatisfactory fracture reduction to be strong predictors of failure (p<0.05). In those with unsatisfactory fracture reduction, 50% required reoperation compared to 17.5% of those with satisfactory reduction. This study highlights the key principles of ensuring adequate intraoperative reduction and fixation, in keeping with GIRFT principles. Avoiding secondary reoperation is crucial to prevent long-term negative outcomes for this typically high functional demand group of patients. We recommend regular, consultant peer review of post-operative imaging as a method of identifying substandard fracture fixations and those at risk of failure. This will allow opportunities for teaching, clinical improvement, and multidisciplinary team (MDT) discussions of at-risk patients.