EARLY OUTCOMES OF FEMORAL NECK VERSUS INTERTROCHANTERIC FRACTURES: A RETROSPECTIVE COHORT STUDY FROM JORDAN

Background: Femoral fractures at the proximal end account for a significant burden of postoperative complications, immobility, and immediate mortality, especially amongst the elderly. Intertrochanteric and femoral neck fractures are anatomically dissimilar and necessitate distinct surgical procedures to repair them. Nevertheless, little information exists about any differences in the early outcomes between the two types of fractures in Jordanian hospitals. Aims: To compare postoperative complications, ambulation at discharge, 90-day mortality, and a composite adverse outcome between patients with femoral neck fractures and those with intertrochanteric fractures. Methods: In this retrospective cohort study, the charts of the patients with proximal femoral fractures who were admitted to Prince Hashim Bin Al Hussein Military Hospital and Prince Rashid Ben Al-Hasan Military Hospital were reviewed from June 2024 until February 2026. Patients with radiographically proven femoral neck or intertrochanteric fractures and postoperative results were included. Patients with fractures of other patterns or those without proper records were excluded. Collected variables were age, gender, fracture location, presence of comorbidities, time to operation, postoperative complications, ability to walk at discharge, and mortality within 90 days. The main outcome of this study was postoperative complications. Secondary outcomes included inability to ambulate at discharge, mortality within 90 days, and a combined outcome including the above three. Comparison of categorical variables made through chi-square test or Fisher's exact test, whereas continuous variables compared through t-test or Mann-Whitney U test depending on the nature of the data. Multivariate logistic regression was used to evaluate the relationship between the location of the fracture and each of the outcomes after adjusting for age, gender, comorbidity, and time to surgery. Results: A total of 182 patients were included, with a mean age of 73.66 years; 59.34% were female, and 62.64% had intertrochanteric fractures. Postoperative complications occurred in 17.03% of patients, 82.87% were ambulatory at discharge, and 6.04% died within 90 days. Patients with intertrochanteric fractures were older than those with femoral neck fractures (75.95 vs. 69.85 years; p = 0.002), but had a lower rate of postoperative complications (10.53% vs. 27.94%; p = 0.002). After adjustment, intertrochanteric fractures were associated with lower odds of postoperative complications (OR = 0.22, 95% CI: 0.09–0.50; p < 0.001) and 90-day mortality (OR = 0.21, 95% CI: 0.05–0.80; p = 0.026). Increasing age was independently associated with both postoperative complications (OR = 1.05 per year; p = 0.011) and 90-day mortality (OR = 1.07 per year; p = 0.028). Conclusion: Although such fractures are common in elderly patients, intertrochanteric fractures had a statistically significant reduced like lihood of postoperative complication and 90-day mortality compared to femoral neck fractures. Older age was an independent risk factor for both adverse outcomes. It is evident that there is the need for fracture classification and patient age during early postoperative risk assessment of proximal femur fractures.