Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures

Intracapsular hip fractures in young adults have a significant risk of complications. Consequently, some authors advocate urgent and/or open fracture reduction. Our aim was to analyse outcomes following such fractures with reference to influence of fracture displacement, timing of surgery and method of reduction (open/closed) on the incidence of non-union (NU) and avascular necrosis (AVN). METHODS: Specific search terms were used to retrieve relevant published studies from 1966 to May 2003. RESULTS: Eighteen studies involving 564 fractures were analysed. The overall incidence of NU was 50/564 (8.9%) and AVN was 130/564 (23.0%). There was a higher incidence of NU and AVN following displaced than undisplaced fractures. NU occurred more frequently after open reduction than closed reduction (10/89 [11.2%] versus 13/275 [4.7%]). There was an increased incidence of AVN after closed than open reduction but this was no longer statistically significant when one study with a markedly higher reported incidence of AVN was excluded. The difference in the incidence of NU and AVN following early (<12h) or late (>12 h) surgery was not significant for either NU or AVN. CONCLUSION: Early or open reduction of these fractures may not reduce the risk of NU or AVN. There is a suggestion of a higher incidence of NU following open reduction than closed reduction. Randomised studies with 2 year follow-up are required to report on a larger number of patients before definite conclusions on treatment can be made.