Same location, different patients: a comparison of metastatic and conventional femoral neck fractures

Although conventional and metastatic femoral neck fractures (FNF) represent distinct patient populations in routine clinical practice, treatment management is generally similar for both groups. Systematic treatment approaches for FNF are currently used and supported by clinical guidelines; however, patients with metastatic FNF are generally managed according to treatment protocols developed for conventional FNF. The aim of this study was to determine whether the treatment strategy for conventional FNF is effective for patients with metastatic FNF.

This retrospective study included 185 patients diagnosed with conventional FNF and 71 patients with metastatic FNF who underwent endoprosthetic reconstruction at a nationwide tertiary orthopedic oncology center. The primary outcome measures were patient- and hospital-related factors potentially affecting survival in the two groups. Secondary outcomes included complications such as thrombotic events, decubitus ulcers, and erythrocyte transfusion requirements.

Patients with metastatic FNF had significantly lower survival rates (p=0.021), higher rates of complications including thrombotic events (p=0.030) and decubitus ulcers (p=0.029), longer operative times (p<0.001), greater perioperative blood loss (p<0.001), and increased erythrocyte transfusion requirements (p<0.001). Compared with the conventional FNF group, metastatic FNF patients also had longer preoperative and postoperative hospital stays (p<0.001) and delayed postoperative mobilization (p=0.017).

Although treatment management for conventional femoral neck fractures has been standardized in orthopedic practice through established algorithms, these protocols do not adequately address the needs of patients with metastatic femoral neck fractures, who experience higher complication rates and lower survival.