Short summary

The project consists of four planned studies: A systematic review, a register based study, a randomized controlled trial and a qualitative study. In a collaboration between several hospitals this project will examine different internal fixation methods for femoral neck fractures in young adults and will elucidate the treatment methods and outcomes from several different angles with different study methods.

Rationale

Hip fractures, including femoral neck fractures, are life-altering events that can significantly impair the ability to independently perform basic daily activities. While hip fractures predominantly affect the elderly population, younger adults under the age of 65 constitute approximately 10% of admissions for femoral neck fractures in the Region of Southern Denmark. Research in the field of femoral neck fractures among younger adults is extremely limited, leaving many aspects yet to be illuminated. For younger adults with femoral neck fractures, there are higher demands for their functional outcomes post-treatment, as this patient group is often still active in the workforce. Consequently, there is a greater need for them to regain independence and return to both work and leisure activities. The standard treatment for femoral neck fractures in young adults is internal fixation with screws or a combination of plate and screws. This preference is due to the preservation of the native hip joint being preferable when considering the patients' longer life expectancy. However, treatment with internal fixation carries a high complication rate. The limited success of internal fixation of femoral neck fractures prompts a deeper understanding of reoperation rates and mortality based on choice of implant as well as a deeper understanding of the lived experiences of young adults (18-64 years) with complications. The perspectives and lived experiences of younger adults are notably lacking in the literature, whereas there has been substantial research on the lived experiences of elderly patients with femoral neck fractures. Only one study has been published regarding lingering challenges for younger patients with hip fractures, elucidating the patients' feelings of increased wariness and growing old from one day to the next, as well as feelings of being neglected in a healthcare system not equipped for younger people with hip fractures. The young patients' perspectives on pain, functional limitations, and psychological impact can help guide future treatment strategies Unlike hip fractures in the elderly, where treatment protocols are well-established, there is a paucity of evidence-based guidelines for young adults. Research is essential to establish standardised protocols and improve treatment consistency as well as outcome. There are a variety of implants and no clear consensus exists regarding which implant is superior in the management of femoral neck fractures in young adults. The specific outcomes based on the type of implant used for internal fixation in this age group (<65 years old) remain poorly described, necessitating further data. Aim In a collaboration between multiple hospitals, the overall aim is to investigate various implants for the treatment of femoral neck fractures and their treatment outcomes in young adults under the age of 65. Additionally, we will endeavour to elucidate the lived experiences of those who have encountered challenges following internal fixation of femoral neck fractures.

Description of the cohort

The population studied is young adults with femoral neck fractures between 18 and 65 years of age. The register based study will include data from the national danish registries on young adults with femoral neck fractures. The RCT will include 54 young adults with femoral neck fractures from Odense University Hospital and Aarhus University Hospital. The qualitative study will include 8-12 patients undergoing a secondary operation after internal fixation of a femoral neck fracture from Odense University Hospital and Sygehus Lillebaelt.

Data and biological material

Demographics, radiological imaging, questionnaire data, interviews, data from patient journals, data from national registries.

Collaborating researchers and departments

Department of Orthopaedic Surgery, Kolding Hospital

• Charlotte Abrahamsen

Department of Orthopaedic Surgery, Vejle Hospital

• Claus Varnum

Department of Orthopaedic Surgery, Aarhus University Hospital

• Per Gundtoft
• Maiken Stilling
• Emil Toft Petersen