Failure after operative repair is higher for ballistic femoral neck fractures than for closed, blunt-injury fractures: a multicenter retrospective cohort study
Introduction The purpose of this study was to describe the outcomes after operative repair of ballistic femoral neck fractures. To better highlight the devastating nature of these injuries, we compared a cohort of ballistic femoral neck fractures to a cohort of young, closed, blunt-injury femoral ne...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-02-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001241.full |
| _version_ | 1797320918766190592 |
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| author | Ranjan Gupta Henry Tout Shu Diane Ghanem Davis L. Rogers Oscar Covarrubias Paul Izard Jacques Hacquebord Philip Lim Greg M. Osgood Babar Shafiq |
| author_facet | Ranjan Gupta Henry Tout Shu Diane Ghanem Davis L. Rogers Oscar Covarrubias Paul Izard Jacques Hacquebord Philip Lim Greg M. Osgood Babar Shafiq |
| author_sort | Ranjan Gupta |
| collection | DOAJ |
| description | Introduction The purpose of this study was to describe the outcomes after operative repair of ballistic femoral neck fractures. To better highlight the devastating nature of these injuries, we compared a cohort of ballistic femoral neck fractures to a cohort of young, closed, blunt-injury femoral neck fractures treated with open reduction and internal fixation (ORIF).Methods Retrospective chart review identified all patients presenting with ballistic femoral neck fractures treated at three academic trauma centers between January 2016 and December 2021, as well as patients aged ≤50 with closed, blunt-injury femoral neck fractures who received ORIF. The primary outcome was failure of ORIF, which includes the diagnosis of non-union, avascular necrosis, conversion to total hip arthroplasty, and conversion to Girdlestone procedure. Additional outcomes included deep infection, postoperative osteoarthritis, and ambulatory status at last follow-up.Results Fourteen ballistic femoral neck fractures and 29 closed blunt injury fractures were identified. Of the ballistic fractures, 7 (50%) patients had a minimum of 1-year follow-up or met the failure criteria. Of the closed fractures, 16 (55%) patients had a minimum of 1-year follow-up or met the failure criteria. Median follow-up was 21 months. 58% of patients with ballistic fractures were active tobacco users. Five of 7 (71%) ballistic fractures failed, all of which involved non-union, whereas 8 of 16 (50%) closed fractures failed (p=0.340). No outcomes were significantly different between cohorts.Conclusion Our results demonstrate that ballistic femoral neck fractures are associated with high rates of non-union. Large-scale multicenter studies are necessary to better determine optimal treatment techniques for these fractures.Level of evidence Level III. Retrospective cohort study. |
| first_indexed | 2024-03-08T04:50:01Z |
| format | Article |
| id | doaj.art-cb5e485f170e4929b7dfc911b6a13f9f |
| institution | Directory Open Access Journal |
| issn | 2397-5776 |
| language | English |
| last_indexed | 2024-03-08T04:50:01Z |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj.art-cb5e485f170e4929b7dfc911b6a13f9f2024-02-08T06:35:07ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-02-019110.1136/tsaco-2023-001241Failure after operative repair is higher for ballistic femoral neck fractures than for closed, blunt-injury fractures: a multicenter retrospective cohort studyRanjan Gupta0Henry Tout Shu1Diane Ghanem2Davis L. Rogers3Oscar Covarrubias4Paul Izard5Jacques Hacquebord6Philip Lim7Greg M. Osgood8Babar Shafiq9Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, IndiaOrthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USAOrthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USAOrthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USAOrthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USAOrthopaedic Surgery, New York University Grossman School of Medicine, New York, New York, USAOrthopaedic Surgery, New York University Grossman School of Medicine, New York, New York, USAOrthopaedic Surgery, University of California Irvine School of Medicine, Irvine, California, USAOrthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USAOrthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USAIntroduction The purpose of this study was to describe the outcomes after operative repair of ballistic femoral neck fractures. To better highlight the devastating nature of these injuries, we compared a cohort of ballistic femoral neck fractures to a cohort of young, closed, blunt-injury femoral neck fractures treated with open reduction and internal fixation (ORIF).Methods Retrospective chart review identified all patients presenting with ballistic femoral neck fractures treated at three academic trauma centers between January 2016 and December 2021, as well as patients aged ≤50 with closed, blunt-injury femoral neck fractures who received ORIF. The primary outcome was failure of ORIF, which includes the diagnosis of non-union, avascular necrosis, conversion to total hip arthroplasty, and conversion to Girdlestone procedure. Additional outcomes included deep infection, postoperative osteoarthritis, and ambulatory status at last follow-up.Results Fourteen ballistic femoral neck fractures and 29 closed blunt injury fractures were identified. Of the ballistic fractures, 7 (50%) patients had a minimum of 1-year follow-up or met the failure criteria. Of the closed fractures, 16 (55%) patients had a minimum of 1-year follow-up or met the failure criteria. Median follow-up was 21 months. 58% of patients with ballistic fractures were active tobacco users. Five of 7 (71%) ballistic fractures failed, all of which involved non-union, whereas 8 of 16 (50%) closed fractures failed (p=0.340). No outcomes were significantly different between cohorts.Conclusion Our results demonstrate that ballistic femoral neck fractures are associated with high rates of non-union. Large-scale multicenter studies are necessary to better determine optimal treatment techniques for these fractures.Level of evidence Level III. Retrospective cohort study.https://tsaco.bmj.com/content/9/1/e001241.full |
| spellingShingle | Ranjan Gupta Henry Tout Shu Diane Ghanem Davis L. Rogers Oscar Covarrubias Paul Izard Jacques Hacquebord Philip Lim Greg M. Osgood Babar Shafiq Failure after operative repair is higher for ballistic femoral neck fractures than for closed, blunt-injury fractures: a multicenter retrospective cohort study Trauma Surgery & Acute Care Open |
| title | Failure after operative repair is higher for ballistic femoral neck fractures than for closed, blunt-injury fractures: a multicenter retrospective cohort study |
| title_full | Failure after operative repair is higher for ballistic femoral neck fractures than for closed, blunt-injury fractures: a multicenter retrospective cohort study |
| title_fullStr | Failure after operative repair is higher for ballistic femoral neck fractures than for closed, blunt-injury fractures: a multicenter retrospective cohort study |
| title_full_unstemmed | Failure after operative repair is higher for ballistic femoral neck fractures than for closed, blunt-injury fractures: a multicenter retrospective cohort study |
| title_short | Failure after operative repair is higher for ballistic femoral neck fractures than for closed, blunt-injury fractures: a multicenter retrospective cohort study |
| title_sort | failure after operative repair is higher for ballistic femoral neck fractures than for closed blunt injury fractures a multicenter retrospective cohort study |
| url | https://tsaco.bmj.com/content/9/1/e001241.full |
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