Effect Of Depression On Femoral Head Avascular Necrosis From Femoral Neck Fracture In Younger Than60Years Adults

Background and ObjectiveIn contemporary society, hip fractures are common and comprise about20%of the operative workload of an orthopedic trauma unit. These fractures are primarily a disease of individuals older than50years. The surgical treatments of femoral neck fracture mainly include reduction and internal fixation and hip replacement. Hip replacement is mainly performed in patients older than60years, while patients younger than60years are more willing to accept the treatment of reduction and internal fixation. After being performed reduction and internal fixation, the femoral head is still retained, so, femoral head avascular necrosis (AVN) may happen. There are many causes of AVN, including vascular damage, tamponade effect, fragment displacement, procedure delay, procedure type, surgical technique, and biomechanics. Depression is a functional mental disorder, and its main clinical symptoms are low mood, thinking inhibition, and motorial inhibition. In many systemic diseases research, the effect of depression on normal physiological function has been identified; it will affect the rehabilitation of the diseases. However, the relationship between depression and femoral head AVN has not been reported in previous studies. The purpose of this study was to determine the impact of depression on AVN from femoral neck fracture in younger than60years adults, and the relationship between depression and postoperative quality of life.MethodsFrom July2002to July2010, the Beck Depression Inventory-Ⅱ (BDI-Ⅱ) was completed by486patients (267male,219female; average age,41.7±10.2years; range20-60years) with femoral neck fractures after being performed closed reduction and internal fixation with3cannulated screws. Patients were divided into groups according to BDI-Ⅱ score:a depressed group (DG, BDI-Ⅱ score≥14) and a non-depressed group (NDG, BDI-Ⅱ score<14). The postoperative diagnosis was confirmed by typical plain radiographic appearances and single photon-emission computed tomography (SPECT). Quality of life among patients was assessed using the Short Form-36(SF-36) questionnaire. Statistical analysis was used to access the relationship between depression and AVN and quality of life.ResultsIn our study, the patients were followed for an average of28months (range,24-37months). The overall incidence of depression and AVN were32.1%(156of486) and21.0%(102of486), respectively. Seventy-five patients (48.1%) in DG and27patients (8.2%) in NDG ultimately developed AVN. Multiple logistic regression model analysis showed that the severity of fracture and depression are both correlated with AVN (OR=1.45,3.21). Besides, multiple linear regression analysis showed that, in addition to sex, partner status, employment status, living alone, frequency of exercise, severity of fractures, and length of hospital stay, depression is associated with patients’quality of life (P=0.001).ConclusionThe results of our study add to the growing evidence that depression in younger than60years adults with femoral neck fractures may increase postoperative femoral head AVN risk, and greatly affects patients’quality of life. Depression may be a predictor of femoral head AVN and poor quality of life.