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Purpose <p>Despite distinct clinical characteristics, few studies evaluate insufficiency fracture (IF) outcomes. This study compares IFs to traumatic proximal femur fractures to better characterize IF injuries.</p> Methods <p>A retrospective cohort study on 5230 patients undergoing operative management for femoral neck, intertrochanteric, or subtrochanteric fractures (2013–2024) was performed. IFs were identified as atraumatic, non-pathological injuries, confirmed radiographically. Controls were non-pathological traumatic injuries. Propensity score matching, T-test, Chi-square, and Monte Carlo approximation were conducted.</p> Results <p>Forty-one IFs and 37 traumatic fractures were included. Demographics were similar between groups (<i>p</i> &gt; 0.05). Pre-injury, patients with traumatic fractures were more likely community ambulators (83.3% versus 50.0%, <i>p</i> = 0.003); patients with IFs were more likely household ambulators (42.5% versus 11.1%, <i>p</i> = 0.004), used assistive devices (65.9% versus 27.0%, <i>p</i> &lt; 0.001), and had higher CCI scores (1.46 ± 1.61 versus 0.73 ± 0.96, <i>p</i> = 0.02). IFs commonly involved the femoral neck (70.7%), while traumatic fractures were commonly trochanteric (89.2%, <i>p</i> &lt; 0.001). Accordingly, nail fixation was common with traumatic fractures (83.8%), while IFs were managed with nails (36.6%), hemiarthroplasty (24.4%), and total hip arthroplasty (24.4%, <i>p</i> &lt; 0.001). Patients with traumatic fractures had longer hospital stays (10.08 ± 7.35 versus 5.80 ± 3.16&#xa0;days, <i>p</i> = 0.002) and higher ICU transfer rates (21.6% versus 0.0%, <i>p</i> = 0.002).</p> Conclusion <p>Despite worse physiological reserve, patients with IFs have more favorable hospital courses compared to traumatic fractures, highlighting unique clinical considerations of IFs and the importance of distinguishing these injuries.</p>

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Are Outcomes of Insufficiency Mechanism Fractures of the Proximal Femur Different from Traumatic Injury Patterns?

  • 期刊论文

  • 发表日期：

    2026年1月12日

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  • Chloe Cecile Fong,
  • Benjamin Hammond,
  • Danielle Olson,
  • Sanjit R. Konda,
  • Kenneth A. Egol

摘要

Purpose

Despite distinct clinical characteristics, few studies evaluate insufficiency fracture (IF) outcomes. This study compares IFs to traumatic proximal femur fractures to better characterize IF injuries.

Methods

A retrospective cohort study on 5230 patients undergoing operative management for femoral neck, intertrochanteric, or subtrochanteric fractures (2013–2024) was performed. IFs were identified as atraumatic, non-pathological injuries, confirmed radiographically. Controls were non-pathological traumatic injuries. Propensity score matching, T-test, Chi-square, and Monte Carlo approximation were conducted.

Results

Forty-one IFs and 37 traumatic fractures were included. Demographics were similar between groups (p > 0.05). Pre-injury, patients with traumatic fractures were more likely community ambulators (83.3% versus 50.0%, p = 0.003); patients with IFs were more likely household ambulators (42.5% versus 11.1%, p = 0.004), used assistive devices (65.9% versus 27.0%, p < 0.001), and had higher CCI scores (1.46 ± 1.61 versus 0.73 ± 0.96, p = 0.02). IFs commonly involved the femoral neck (70.7%), while traumatic fractures were commonly trochanteric (89.2%, p < 0.001). Accordingly, nail fixation was common with traumatic fractures (83.8%), while IFs were managed with nails (36.6%), hemiarthroplasty (24.4%), and total hip arthroplasty (24.4%, p < 0.001). Patients with traumatic fractures had longer hospital stays (10.08 ± 7.35 versus 5.80 ± 3.16 days, p = 0.002) and higher ICU transfer rates (21.6% versus 0.0%, p = 0.002).

Conclusion

Despite worse physiological reserve, patients with IFs have more favorable hospital courses compared to traumatic fractures, highlighting unique clinical considerations of IFs and the importance of distinguishing these injuries.