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Fixation of Basicervical Hip Fractures: Are Outcomes Distinct from Neighboring Valgus Neck and Intertrochanteric
Benjamin Hammond1, Chloe Fong1, Dillon Murugesan1
1Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.
Insights
Basicervical (BC) hip fractures show similar long-term outcomes to intertrochanteric (IT) and valgus femoral neck (VFN) fractures after fixation. However, BC fractures have higher minor complication rates, suggesting a need for optimized acute management strategies.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Geriatric Fracture Care
Background:
- Basicervical (BC) hip fractures present a unique proximal femur fracture pattern with uncertain optimal treatment.
- Understanding demographic, perioperative, and outcome differences is crucial for effective management.
Purpose of the Study:
- To compare demographic, perioperative, and outcome data for BC fractures versus intertrochanteric (IT) and valgus femoral neck (VFN) fractures treated with internal fixation.
Main Methods:
- Retrospective review of prospectively collected data from a hip fracture database (2 urban trauma centers, Oct 2014 - Mar 2025).
- Inclusion of AO/OTA-classified 31B3 (BC), 31A1.2 (IT), and 31B1.1 (VFN) fractures treated with non-arthroplasty fixation.
- Comparison of demographics, comorbidities, fracture characteristics, surgical constructs, and outcomes using multivariate regression.
Main Results:
- 875 patients included: 122 BC, 523 IT, 230 VFN.
- BC cohort younger, higher ASA scores, more household ambulators than VFN, but similar comorbidities.
- BC group had more minor in-hospital complications than VFN, even after adjustment; no differences in 30-day mortality or major complications. Long-term outcomes were comparable across all groups.
Conclusions:
- Basicervical hip fractures demonstrate comparable long-term outcomes to IT and VFN fractures following internal fixation.
- Higher rates of minor complications in the BC group suggest potentially greater perioperative risk.
- Further research is needed to optimize acute management strategies for this distinct fracture pattern.
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.
