• David J Stockton, Kelly A Lefaivre, Daniel E Deakin, Georg Osterhoff, Andrew Yamada, Henry M Broekhuyse, Peter J OʼBrien, and Gerard P Slobogean.
• *Division of Orthopaedic Trauma, Department of Orthopaedics, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada; †Consultant Orthopaedic Trauma Surgeon, Nottingham University Hospital, Nottingham, United Kingdom; and ‡Vancouver-Fraser Medical Program, Faculty of Medicine, University of British Columbia, Vancouver British Columbia, Canada.
• J Orthop Trauma. 2015 Sep 1; 29 (9): e293-8.

ObjectivesTo describe the incidence and magnitude of femoral neck fracture shortening in patients age younger than 60 years. Secondarily, to examine predictors of fracture shortening.DesignRetrospective chart review.SettingLevel I trauma centre.Patients/ParticipantsSixty-five patients with a median age of 51 years (interquartile range: 42-56 years) were included. Seventy-one percent were male, 75% were displaced fractures, and 78% were treated with cancellous screws.InterventionInternal fixation with multiple cancellous screws or sliding hip screw (SHS) + derotation screw.Main Outcome MeasurementsRadiographic femoral neck shortening at a minimum of 6 weeks after fixation.ResultsFifty-four percent of patients had ≥5 mm of femoral neck shortening (22% had between ≥5 and <10 mm and 32% ≥10 mm). Initially, displaced fractures shortened more than undisplaced fractures (mean: 8.1 vs. 2.2 mm, P < 0.001), and fractures treated with SHS + derotation screw shortened more than fractures with cancellous screws alone (10.7 vs. 5.5 mm, P = 0.03). Even when adjusting for initial fracture displacement, fractures treated with SHS + derotation screw shortened an average of 2.2 mm more than fractures treated with screws alone (P = 0.03).ConclusionsThe incidence of clinically significant shortening in our young femoral neck fracture population was higher than anticipated, and 32% of patients experienced severe shortening of >1 cm. Our findings highlight the need for further research to determine the impact of severe shortening on functional outcome and to determine if implant selection affects fracture shortening.Level Of EvidencePrognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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