Scientific Article   |    
Comparison of Early and Delayed Fixation of Subcapital Hip Fractures in Patients Sixty Years of Age or Less
Rina Jain, MD, FRCS(C); Manfred Koo, MD, MSc; Hans J. Kreder, MD, MPH, FRCS(C); Emil H. Schemitsch, MD, FRCS(C); J. Rod Davey, MD, FRCS(C); Nizar N. Mahomed, MD, ScD, FRCS(C)
View Disclosures and Other Information
Investigation performed at the University Health Network, Toronto Western Hospital, University of Toronto; Sunnybrook and Women's College Health Sciences Centre; and St. Michael's Hospital, Toronto, Ontario, Canada

Rina Jain, MD, FRCS(C)
Division of Orthopaedic Surgery, The Scarborough Hospital, General Division, 895 Don Mills Road, One Morneau Sabeco Centre, Suite 100, Toronto, ON M3C 1W3, Canada

Manfred Koo, MD, MSc
J. Rod Davey, MD, FRCS(C)
Nizar N. Mahomed, MD, ScD, FRCS(C)
Division of Orthopaedic Surgery, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada

Hans J. Kreder, MD, MPH, FRCS(C)
Division of Orthopaedic Surgery, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, MG 365, Toronto, ON M4N 3M5, Canada

Emil H. Schemitsch, MD, FRCS(C)
Division of Orthopaedic Surgery, St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2002 Sep 01;84(9):1605-1612
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


Background: Subcapital hip fractures in younger patients are generally treated with internal fixation rather than with primary hemiarthroplasty, which is generally reserved for older, low-demand patients. Avascular necrosis can occur following this injury because of disruption of the femoral head blood supply. Some believe that emergent fracture reduction is necessary to minimize the risk of avascular necrosis. The purposes of this study were (1) to investigate the functional outcomes of subcapital hip fractures in patients sixty years old or younger and (2) to compare the rates of avascular necrosis after early and delayed fracture fixation.

Methods: This retrospective study included adults in whom a subcapital hip fracture had been treated with reduction and internal fixation when they were sixty years of age or less and who had been followed clinically for a minimum of two years. The patients were divided into two groups: those treated with early fixation (within twelve hours after the injury) and those treated with delayed fixation (more than twelve hours after the injury). Functional outcomes were assessed with use of the Short Form-36 and the Western Ontario and McMaster University (WOMAC) Osteoarthritis Index. The rates of avascular necrosis were compared between the two groups.

Results: Thirty-eight patients (average age, 46.4 years) participated in the study. Twenty-nine patients had a displaced subcapital hip fracture. Fifteen patients underwent early fracture fixation, and the remainder underwent delayed fixation. No differences in the Short Form-36 (p = 0.68) or WOMAC (p = 0.69) scores were seen between the early and delayed fixation groups. Radiographic evidence of avascular necrosis developed in six patients treated with delayed fixation, one of whom had had an undisplaced fracture preoperatively, and in no patient treated with early fixation. The difference in the rates of avascular necrosis was significant (p = 0.03).

Conclusions: Although delayed surgical treatment of subcapital hip fractures was associated with a higher rate of avascular necrosis, this complication did not significantly affect functional outcome. Longer follow-up is required to assess the effect of avascular necrosis on the development of arthritis and on long-term patient function. Although the results could be biased because patients were not randomly assigned to delayed or early fixation, the data suggest that urgent reduction and fracture fixation within twelve hours after a displaced subcapital hip fracture in high-demand patients may be associated with a reduced rate of radiographic signs of avascular necrosis.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    California - Mercy Medical Group
    Louisiana - Ochsner Health System