Intracapsular hip fractures in the young adult patient: Early vs. late intervention

Introduction: The treatment of choice for intracapsular hip fractures in younger patients is reduction and internal fixation as opposed to primary arthroplasty, which is generally reserved for older patients. The long-term potential consequences are avascular necrosis (AVN) and non-union (NU) with reported rates of 23% and 9%, respectively. Previous studies have been in dispute in regard to the effect of time-to-surgery upon the risk of the complications. The purpose of this study was to compare the rates of AVN, NU and to examine the rate of revision arthroplasty after early and delayed fracture fixation.

Methods: This retrospective study included fifty- five adult patients, 65 years and younger, treated with reduction and internal fixation following an intra-capsular hip fracture. The patients were divided into two groups; patients treated with early fracture fixation (EFF) (<12 hours after injury) and patients treated with delayed fracture fixation (DFF) (>12 hours after injury). Results were compared regarding rates of AVN, NU, conversion to arthroplasty and complications.

Results: Twenty-one patients underwent early fracture fixation, and thirty-four underwent delayed fracture fixation. No significant differences between the EFF and DFF group were noted regarding AVN, NU and conversion to arthroplasty (p>0.05). In the EFF group, 5 patients (23.8%) had AVN, 3 patients (14.3%) had NU and 2 patients (9.5%) ultimately had conversion to arthroplasty. In the DFF group, 3 patients (8.8%) had AVN, 6 patients (17.6%) had NU and 5 patients (14.7%) underwent conversion to arthroplasty. These differences were not significant.

Conclusions: In spite of theoretical advantages for EFF, the results of this study did not demonstrate a benefit regarding rates of AVN, NU and conversion to arthroplasty. While the main advantage of EFF remains a marginally shorter hospitalization, in cases where prudent surgical preparation is required, the delay in surgery should not affect surgical judgment.