Changing Trends in the Treatment of Femoral Neck Fractures

Miller, Benjamin J.; Callaghan, John J.; Cram, Peter; Karam, Matthew D.; Marsh, J. Lawrence; Noiseux, Nicolas

doi:10.2106/jbjs.m.01122

Cited by 74 publications

(37 citation statements)

References 37 publications

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“…Only very recently has a change in treatment patterns been identified in the United States. 19 A query of the American Board of Orthopaedic Surgeons database demonstrated that among candidates applying for board certification between 1999 and 2011, utilization of THA for femoral neck fractures increased from 0.7% to 7.7%, with the most dramatic increase in THA use coming in younger patients. Those candidates declaring adult reconstruction as a subspecialty showed the most dramatic increase in use of THA for femoral neck fractures, from 4.3% in 1999 to 21.1% in 2011.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Contemporary Trends in Femoral Neck Fracture Management Reveals Discrepancies in Treatment

Bishop

Yang

Githens

et al. 2016

Geriatr Orthop Surg Rehabil

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Background:Recent evidence supports total hip arthroplasty (THA) as compared to hemiarthroplasty (HA) for the management of displaced femoral neck fractures in a significant subset of elderly patients. The purpose of this study was to examine trends in femoral neck fracture management over the last 12 years.Methods:Using the National Inpatient Sample database, we identified patients treated for femoral neck fractures between 1998 and 2010 with THA, HA, or internal fixation (IF). We examined treatment trends and demographic variables including patient age, gender, socioeconomic status, and payer and hospital characteristics.Results:We identified 362 127 femoral neck fracture patients treated between 1998 and 2010. Overall, there were statistically significant increases in rates of THA and HA, whereas rates of IF decreased. Total hip arthroplasty varied based on patient age, with significant increases occurring in age-groups 0 to 49 years, 50 to 59 years, 60 to 69 years, and 70 to 79 years. Utilization of THA varied significantly based on socioeconomic status and race. Patient sex, urban versus rural hospital location, and teaching versus nonteaching hospital status were not related to rates of THA.Conclusion:Rates of THA for femoral neck fractures increased between 1998 and 2010 in patients younger than 80 years, suggesting that surgeons are responding to clinical evidence supporting THA for the treatment of elderly femoral neck fractures. This is the first study to demonstrate this change and expose disparities in practice patterns over time in response to this evidence in the United States. Further research is indicated to explore the effect of socioeconomic status and race on femoral neck fracture management.

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Section: Discussionmentioning

confidence: 99%

“… 17 , 18 Only very recently has a shift in treatment trends in the United States been identified. 19 Recently published national registry data from Finland and Korea demonstrate an increasing utilization in THA over HA. 20 , 21 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of Contemporary Trends in Femoral Neck Fracture Management Reveals Discrepancies in Treatment

Bishop

Yang

Githens

et al. 2016

Geriatr Orthop Surg Rehabil

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“…The treatment of femoral neck fracture in young patients faces many challenges, and if clinicians fail to provide improper treatment, it may lead to catastrophic consequences for patients [2][3][4][5][12][13][14]. The proportion of patients with femoral neck fractures under 65 years who underwent total hip arthroplasty increased from 1.4-13.1% from 1999 to 2011 [14]. However, due to the longevity of the hip joint and the high activity requirements, arthroplasty surgery is not the best option [3,4,10].…”

Section: Discussionmentioning

confidence: 99%

Gotfried reduction and cannulated screws fixation in the treatment of femoral neck fracture in young adults

Huang

Fang

et al. 2020

Preprint

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Background: Although many available surgical procedures for displaced femoral neck fractures in young patients, there are still many challenges to achieve satisfactory results. The incidence of avascular necrosis and nonunion rates remain relatively high despite the progress in our understanding and surgical technique. The purpose of this study was to evaluate the clinical efficacy of gotfried reduction and cannulated screw fixation in the treatment of femoral neck fracture for young adults.Methods: A retrospective analysis was made on 67 cases from May 2013 to March 2019. They were divided into three groups according to the first postoperative anteroposterior view of hip X-ray: Anatomic reduction (group A), Gotfried positive buttress reduction (group B), and Gotfried negative buttress reduction (group C). The incidence of avascular osteonecrosis of the femoral head (AVN) and the Harris scores of hip joints were compared in three groups at the last follow-up.Results: There were 21 cases (mean age,49.7 ± 11.6) in group A, 24 cases (mean age, 48.6 ± 11.3) in group B, 22 cases (mean age,48.3 ± 12.4) in group C. No significant difference in general preoperative demographics (P>0．05).The incidence of avascular necrosis of femoral head in Group A, B, and C was 19.05%,20.83%, and 22.73 %, respectively, showing no significant difference between groups(P=0．156). The mean Harris hip scores at the final follow-up for groups A (85．6±6．7)and B (84．5±6．2) were significantly higher than group C (74．3±8.3), and the difference was statistically significant(P=0．043).Conclusions: Gotfried positive buttress reduction and fixation for femoral neck fracture may lead to similar clinical results with anatomic reduction, but much better than Gotfried negative buttress reduction. For the patients of femoral neck fracture with severe displacement and difficulty in reduction, it is not necessary to pursue anatomical reduction。Achieving positive valgus reduction can also obtain satisfactory clinical results, and should try to avoid negative buttress.

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“…22 Em 2014, foi publicado um levantamento do American Board of Orthopaedic Surgery Database demonstrando que os cirurgiões americanos, tanto especialistas em quadril quanto cirurgiões do trauma, realizaram mais artroplastias do que osteossínteses em casos de fraturas do colo femoral na terceira idade, em relação à década passada. 23 Diversos estudos destacam o alto risco de falha de osteossínteses de fraturas do colo femoral no idoso. 23,24 Entretanto, poucas pesquisas nacionais descrevem a qualidade de vida após um tratamento preservador da cabeça femoral que obteve sucesso.…”

Section: Discussionunclassified

“…23 Diversos estudos destacam o alto risco de falha de osteossínteses de fraturas do colo femoral no idoso. 23,24 Entretanto, poucas pesquisas nacionais descrevem a qualidade de vida após um tratamento preservador da cabeça femoral que obteve sucesso. Também já é consenso que os resultados das artroplastias do quadril são significantemente mais satisfatórios quando a motivação da cirurgia é a degeneração artrítica coxofemoral do que quando realizamos a substituição articular por fratura do colo femoral.…”

Section: Discussionunclassified

A qualidade de vida após a fratura do colo femoral nos idosos: um estudo comparativo entre fixação interna e artroplastias

Sansanovicz

Baras

Silva

et al. 2016

Rev. Fac. Ciênc. Méd. Sorocaba

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A qualidade de vida após a fratura do colo femoral nos idosos: um estudo comparativo entre fixação interna e artroplastiasThe quality of life after a femoral neck fracture in elderly patients: a comparative study between internal fixation and arthroplasties RESUMOIntrodução: A fratura do colo femoral é uma patologia frequente na população idosa, com cerca de 100 mil casos por ano no Brasil. O tratamento cirúrgico por meio da fixação interna ou da substituição artroplástica do quadril é preconizado atualmente. O tratamento não cirúrgico é reservado aos casos de exceção. Objetivo: Comparar a qualidade de vida pós-operatória de pacientes tratados por fratura do colo femoral por meio de duas técnicas distintas: artroplastia do quadril e fixação interna. Métodos: Por meio do questionário SF-36, estudamos a qualidade de vida de 60 pacientes com mais de 65 anos, tratados entre 2004 e 2012 em nosso serviço. Metade dos pacientes foi submetida à fixação interna e a outra metade à substituição artroplástica da articulação do quadril. Resultados: Médias mais altas na ampla maioria dos parâmetros do questionário foram obtidas pelo grupo que realizou fixação interna, porém sem significância estatística na maioria dessas diferenças. Alguns relatos internacionais sinalizam que pacientes que sofreram uma fratura do colo femoral e foram tratados com fixação interna podem retornar à qualidade de vida anterior à fratura. Paradoxalmente, na atualidade, há uma crescente tendência entre os ortopedistas em optar pela substituição articular protética da articulação do quadril nesses casos. Conclusão: Mais estudos são necessários para definir qual a melhor opção cirúrgica de tratamento. Palavras-chave: fraturas do quadril; artroplastia de quadril; fixação interna de fraturas; qualidade de vida. ABSTRACT Introduction:The femoral neck fracture is a frequent pathology in the elderly population, with about of 100,000 cases per year in Brazil. The surgical treatment by internal fixation or arthroplastic hip replacement is advocated today. The non-surgical treatment is reserved for cases of exception. Objective: To compare the quality of patient postoperative life treated for femoral neck fracture by two different techniques: hip arthroplasty and internal fixation. Methods: Through the SF-36 questionnaire, we study the quality of life of 60 patients with more than 65 years, treated between 2004 and 2012 in our service. Half of the patients was submitted to internal fixation and the other half to the arthroplastic replacement. Results: Higher averages in the large majority of the parameters of the questionnaire were obtained by the group which was carried out by internal fixation, but without statistical significance in most of these differences. Some international reports indicate that patients who have suffered a fracture of the femoral neck and were treated with internal fixation may recover the quality of life they had before the fracture. Paradoxically, there is a growing trend among orthopedic surgeons to perform a hip replacement surger...

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Changing Trends in the Treatment of Femoral Neck Fractures

Abstract: The most substantial changes in treatment of femoral neck fractures were seen in the younger group of patients. Currently, a smaller percentage of board certification candidates are treating femoral neck fractures than those in the past, possibly reflecting a trend toward specialty care.

Cited by 74 publications

References 37 publications

Evaluation of Contemporary Trends in Femoral Neck Fracture Management Reveals Discrepancies in Treatment

Evaluation of Contemporary Trends in Femoral Neck Fracture Management Reveals Discrepancies in Treatment

Gotfried reduction and cannulated screws fixation in the treatment of femoral neck fracture in young adults

A qualidade de vida após a fratura do colo femoral nos idosos: um estudo comparativo entre fixação interna e artroplastias

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