Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Clinical Outcomes of a Multicenter 2 × 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients.

Gerard P Slobogean, Sheila Sprague, Sofia Bzovsky, Taryn Scott, Lehana Thabane, Diane Heels-Ansdell, Robert V O'Toole, Andrea Howe, Greg E Gaski, Lauren C Hill, Krista M Brown, Darius Viskontas, Mauri Zomar, Gregory J Della Rocca, Nathan N O'Hara, Mohit Bhandari

Journal: Journal of orthopaedic trauma 2021;34(10):524-532

PMID: 32732587

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Abstract

OBJECTIVE

To assess whether the fixation method and vitamin D supplementation affect the risk of patient-important outcomes within 12 months of injury in nongeriatric femoral neck fracture patients.

DESIGN

A pilot factorial randomized controlled trial.

SETTING

Fifteen North American clinical sites.

PARTICIPANTS

Ninety-one adults 18-60 years of age with a femoral neck fracture requiring surgical fixation.

INTERVENTION

Participants were randomized to a surgical intervention (sliding hip screw or cancellous screws) and a vitamin D intervention (vitamin D3 4000 IU daily vs. placebo for 6 months).

MAIN OUTCOME MEASUREMENTS

The primary clinical outcome was a composite of patient-important complications (reoperation, femoral head osteonecrosis, severe femoral neck malunion, and nonunion). Secondary outcomes included fracture-healing complications and radiographic fracture healing.

RESULTS

Eighty-six participants with a mean age of 41 years were included. We found no statistically significant difference in the risk of patient-important outcomes between the surgical treatment arms (hazard ratio 0.90, 95% confidence interval 0.40-2.02, P = 0.80) and vitamin D supplementation treatment arms (hazard ratio 0.96, 95% confidence interval 0.42-2.18, P = 0.92).

CONCLUSIONS

These pilot trial results continue to describe the results of current fixation implants, inform the challenges of improving outcomes in this fracture population, and may guide future vitamin D trials to improve healing outcomes in young fracture populations. Although the pilot trial was not adequately powered to detect treatment effects, publishing these results may facilitate future meta-analyses on this topic.

LEVEL OF EVIDENCE

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Address: Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN.; Department of Orthopaedics, University of British Columbia, New Westminster, BC, Canada.; Division of Orthopaedics, Fraser Health Authority, New Westminster, BC, Canada; and.; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO.; Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.

DOI: 10.1097/BOT.0000000000001773