ArticleInternational orthopaedics2026
Factors associated with implant- and bone-related complications and fixation-failure-related readmissions after internal fixation for femoral neck fractures in young and middle-aged adults: a population-based study.
Article in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeInternal fixation is the preferred treatment for femoral neck fractures (FNFs) in young and middle-aged adults, yet early in-hospital implant- and bone-related complications and subsequent readmissions for fixation failure remain poorly characterized. This study examined early complications after FNF fixation and described the burden of readmissions.
methodsAdults aged 18-59 years who underwent FNF open or closed reduction with internal fixation during 2006-2020 were identified in the Nationwide Inpatient Sample. Implant- and bone-related complications, including mechanical, nonunion-related, and osteonecrotic events during the index hospitalizations, were identified using ICD codes. Survey-weighted analyses and multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% CIs. A secondary descriptive analysis evaluated patients readmitted with fixation failure between 2016 and 2020.
resultsAmong 17,509 patients (weighted 85,740), 2% experienced in-hospital implant- or bone-related complications. Independent predictors included older age (aOR 1.01), Black race (vs. White: aOR 1.70), open reduction and internal fixation (vs. closed: aOR 2.46), persistent anaemia (aOR 1.38), hypertension (aOR 1.40), moderate/severe renal disease (aOR 1.92), rheumatic disease (aOR 2.37), and obesity (aOR 1.49). Later admission years were associated with lower risk (2018-2020: aOR 0.61). In a sub-cohort of patients readmitted with fixation failure (n = 1,264; weighted 6,319), revision internal fixation occurred in 38% and osteomyelitis in 30%. Hospital stay was 7.3 days and total hospitalization cost was USD $101,700.
conclusionsEarly implant- and bone-related complications after FNF fixation are associated with multiple demographic, clinical, and procedural factors. Readmissions for fixation failure also represent a substantial clinical and healthcare burden.
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