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Updated: Jun 5, 2025
Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture
Published on: March 3, 2023
Comparison Between in Situ Fixation and Fixation After Closed Reduction in Valgus-Impacted Femoral Neck Fractures: A
Byung-Woong Jang1, Jung-Wee Park2, Jae-Hwi Nho1
1Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, South Korea.
Objectives:
The objective of this study was to compare clinical outcomes between in situ fixation and fixation after closed reduction (CR) in patients aged 50 years and older with valgus-impacted femoral neck fractures using data from multiple centers.
Design:
Retrospective multicenter cohort study.
Setting:
Five tertiary-care university hospitals.
Patient Selection Criteria:
Patients aged 50 years and older, treated with operative fixation of valgus-impacted femoral neck fractures using multiple cannulated screws from 2003 to 2019.
Outcome Measures And Comparisons:
Complications such as fixation failure, osteonecrosis of femoral head (ONFH), and reoperation were compared between the groups (in situ fixation group and fixation after CR group). Postoperative EuroQol-5 Dimension (EQ-5D), Harris Hip Score, and Koval grade were compared.
Results:
The mean age of the 206 patients (161 in situ fixation group, 45 in fixation after CR group) who met the inclusion criteria was 68.9 ± 10.9 years (range, 50-95 years). There were 39 men and 167 women. Fixation failure occurred in 11.2% (6.8% of in situ fixation group vs. 26.7% of fixation after CR group, P = 0.002). Reoperation was required for 10.2% (7.5% of the in situ fixation group vs. 20% of the fixation after CR group, P = 0.023). Fixation failure and reoperation rates were significantly higher in the fixation after the CR group than in the in-situ fixation group (odds ratio = 4.757, P = 0.002 and odds ratio = 3.104, P = 0.023, respectively). At the 2-year follow-up, ONFH occurred in 5.8% (9 out of 161, in situ fixation group vs. 3 out of 45, fixation after CR group). There was no significant difference in the occurrence of ONFH between the 2 groups ( P = 0.727). The Koval's grade at 6 and 12 months demonstrated better results in the in-situ group ( P = 0.027, 0.044, respectively). Postoperative EQ-5D and Harris Hip Score scores showed no statistically significant differences between the 2 groups.
Conclusions:
In patients aged 50 years or older with valgus-impacted femoral neck fractures, when fixation was done after reduction, the reoperation rate was higher due to fixation failure compared with in-situ fixation. There was no significant difference in the incidence of ONFH in valgus-impacted femoral neck fractures regardless of whether reduction was performed.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
