Comparative Outcomes of Surgical Interventions for Femoral Neck Fractures: A Multicenter Analysis and Review of the Literature

Background Femoral neck fractures are a significant source of morbidity and mortality in older adults. This study compared demographics, outcomes and complications between the following treatment options: Open Reduction and Internal Fixation (ORIF), Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA). Methods This was a population-based study using the Centers for Medicare & Medicaid Services dataset from 2017-2021. A total of 67,759 isolated hip fracture patients were analyzed. Multivariate regression analyses adjustmented for age, comorbidities and hospital volume. Outcomes were compared using odds ratios (OR) with 95% confidence intervals (CI). Results ORIF patients were the oldest (36.7% aged 85+), while THA patients were younger (18.6% aged 65-69). Females predominated for overall fracture incidence (66.9%–81.8%). HA patients had significantly higher risks of discharge mortality OR = 1.51 (95% CI 1.24, 1.83), deep venous thrombosis OR = 1.31 (95% CI 1.07, 1.60), cardiac arrest OR = 1.85 (95% CI 1.33, 2.57), pulmonary embolism OR = 1.76 (95% CI 1.38, 2.36), acute kidney injury OR = 1.32 (95% CI 1.24, 1.40) and overall infection compared to ORIF. THA and HA patients were associated with lower odds of rehab discharge (OR = 0.65 and OR = 0.90, respectively). THA was linked to shorter hospital stays (4.3 days) but an increased pulmonary embolism risk OR = 2.39 (95% CI 1.17, 4.88). Conclusions For femoral neck fractures, ORIF had the lowest complication rates. Hemiarthroplasty posed the highest complication risks, including mortality and thromboembolic events. THA appeared better suited for healthier individuals, with shorter hospital stays but higher rates of pulmonary embolism. Complication profiles vary significantly across fixation methods for femoral neck fractures. Individualized surgical planning is essential to balance risks and optimize outcomes for femoral neck fracture patients. There may be an opportunity to more carefully scrutinize surgical decision making for femoral neck fractures that would otherwise be treated with either ORIF or HA.