A Case Series of Young Patients with Low-Energy Femoral Neck Fractures.

Background: Fragility femoral neck fractures are traditionally seen in elderly patients after a low-energy fall. In contrast, displaced femoral neck fractures in young patients are usually associated with high-energy mechanisms such as a fall from height or high-speed motor vehicle collisions. However, patients under the age of 45 with fragility femoral neck fractures represent a unique population, and one that is not well-described. This study aims to describe this population and their current workup. Methods: A single institution retrospective chart review of patients who underwent open reduction internal fixation or percutaneous pinning of femoral neck fractures from 2010-2020 was conducted. Inclusion criteria were patients 16-45 years old and femoral neck fractures with a low-energy mechanism of injury (MOI). Exclusion criteria were high-energy fractures, pathologic fractures, and stress fractures. Patient demographics, MOI, past medical history, imaging studies, treatment plan, lab values, DEXA results, and surgical outcomes were recorded. Results: The average age in our cohort was 33 ± 8.5 y/o. 44% (12/27) were male. Vitamin D level was obtained in 78% (21/27) patients and 71% (15/21) those patients were found to be abnormally low. A DEXA scan was obtained in 48% (13/27) of patients and abnormal bone density was found in 90% (9/10) of available results. 41% (11/27) patients received a bone health consultation. Conclusion: A significant portion of femoral neck fractures in young patients were fragility fractures. Many of these patients did not receive bone health workup and their underlying health condition remained untreated. Our study highlighted a missed opportunity of treatment for this unique and poorly understood population.