Objective:To describe the distribution of femoral neck shortening after internal fixation and to determine whether shortening is associated with inferior hip function at 24 months after a hip fracture in patients 50 years of age or older.Design:Retrospective cohort study.Setting:A secondary analysis of data from 81 clinical centers included in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial.Participants:Three hundred fifty patients, 50 years of age or older, who had an isolated femoral neck fracture and underwent timely operative fixation of the fracture.Intervention:Femoral neck shortening was measured as a categorical variable and classified into one of the following groups, as determined by the Central Adjudication Committee: no shortening, mild shortening (≤5 mm), moderate shortening (6-10 mm), or severe shortening (>10 mm).Main Outcome Measurement:The primary outcome for the current analysis was hip function, as measured by the Western Ontario & McMaster Universities Osteoarthritis Index questionnaire, at 24 months after injury.Results:Two-thirds of patients had no or mild shortening (≤5 mm), whereas one-third of patients had moderate or severe shortening (>5 mm). After adjusting for surgical treatment, a greater amount of femoral neck shortening was found to be associated with poorer hip function (P < 0.01).Conclusions:We found that increasing femoral neck shortening was associated with inferior hip function. Although internal fixation often results in successful union, patients who heal in a shortened position report poorer functional outcomes.Level of Evidence:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Bibliographical noteFunding Information:
The FAITH Study was supported by research grants from the Canadian Institutes of Health Research (MOP-106630 and MCT-87771), National Institutes of Health (1R01AR055267-01A1), Stichting NutsOhra (SNO-T-0602-43), the Netherlands Organization for Health Research and Development (80-82310-97-11032), and Physicians' Services Incorporated. M. Bhandari was also funded, in part, through the Early Research Award Program, which provided funding for the FAITH study as well as by a Canada Research Chair in Musculoskeletal Trauma, which is unrelated to the FAITH study (McMaster University, Hamilton, ON, Canada). Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number 1R01AR055267-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Research reported in this publication was also supported by The County Durham & Tees Valley Comprehensive Local Research Network, which operates as part of the National Institute for Health Research Comprehensive Clinical Research Network in England. The funding sources had no role in design or conduct of the FAITH study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript. J. Felton was supported by the T32 training grant DK067872.
G. P. Slobogean reports research support from the US Department of Defense and the Patient‐Centered Outcomes Research Institute, and is paid consultant with Zimmer Biomet and Smith & Nephew, outside the submitted work. N. N. O'Hara reports stock options from Arbutus Medical, Inc., outside the submitted work. G. J. Della Rocca reports stock options from The Orthopaedic Implant Company and Mergenet, and is a paid consultant with Wright Medical Technology, Inc and Bioeventus, outside the submitted work. K. J. Jeray is a paid consultant with Zimmer and Radius, outside the submitted work. S. A. Sprague reports employment/salary from McMaster University, other from Global Research Solutions, outside the submitted work. M. Swiontkowski reports grants from National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), during the conduct of the study; other financial support from JBJS, outside the submitted work. M. Bhandari reports grants from Canadian Institutes of Health Research, grants from National Institutes of Health, grants from Stichting NutsOhra, grants from The Netherlands Organisation for Health Research and Development, grants from Physicians' Services Incorporated, grants from Stryker Inc, during the conduct of the study, grants and personal fees from Stryker Inc., personal fees from Smith & Nephew, grants and personal fees from Amgen, grants from DePuy, grants and personal fees from Eli Lilly, grants and personal fees from DJO Global Inc, personal fees from Zimmer, personal fees from Ferring, grants from the Canada Research Chair in Musculoskeletal Trauma, outside the submitted work. The remaining authors report no conflicts of interest.
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- femoral neck fracture
- femoral neck shortening
- hip function
- internal fixation