Incidence and treatment of intracapsular femoral neck fractures in Germany

Abstract

Introduction Intracapsular femoral neck fractures are one of the most common fractures in Germany. Nevertheless, the epidemiology and treatment modalities are not described comprehensively. For this reason, this study highlights the epidemiology of femoral neck fractures in different age groups and summarizes treatment strategies within the period from 2009 to 2019 based on nationwide data. Materials and methods In this retrospective cohort study all cases of intracapsular femoral neck fractures (ICD-10: S72.0) between 2009 and 2019 in Germany were analyzed with regard to epidemiology, incidence and treatment. Operation and procedure classification system (OPS)- codes in combination with intracapsular femoral neck fracture as main diagnosis were taken to investigation. Data was provided by the Federal Statistical Office of Germany (Destatis). Results A total of 807,834 intracapsular femoral neck fractures with a mean incidence of 110.0 per 100,000 inhabitants annually was detected within eleven years. In 68.8% of all fractures patients were female. Most patients were older than 70 years (82.4%), and 56.7% were older than 80 years. The overall increase of fracture numbers between 2009 and 2019 was 23.2%. Joint replacement has been most often performed (80.4%). Hemiarthroplasty (56.8%) and total hip arthroplasty (22.8%) were the most common procedures with an increase of 27.1 and 38.6%, respectively. The proportion of cemented hemiarthroplasties was 86.2% while 51.3% of all total hip arthroplasties were totally or partially cemented. Osteosyntheses were mainly conducted using dynamic compression screws (34.0%), conventional screws (31.3%) and nails (22.2%). Conclusion The incidence of intracapsular femoral neck fractures in Germany has been increasing continuously within the last decade. In particular, patients over 80 years suffered predominantly from this type of fracture. The majority was treated with a joint replacement procedure, mainly cemented hemiarthroplasty.

Aseptic revisions and pulmonary embolism after surgical treatment of femoral neck fractures with cemented and cementless hemiarthroplasty in Germany: an analysis from the German Arthroplasty Registry (EPRD)

“…Geographical differences are also noticeable in this context, with mainly cemented HA being used in Europe, whereas mainly uncemented HA are used in the USA. [ 3 , 31 ]. Several studies reported an increased in-patient mortality for cemented joint replacement surgeries and demonstrated an increased mortality for cemented HA with an odds ratio of 1.64 (95% CI 1.35–2.00) within the first 48 h after surgery [ 30 , 32 ].…”

“…Fractures of the femoral neck (FNF) are among the most common fractures in the German population, with an annual number of over 81,000 fractures and an incidence of 120.2 per 100,000 inhabitants. Both an increase of 23% between 2009 and 2019 and a high incidence in the population over 70 years of age (508.2 fractures per 100,000 population/year) underline the relevance of these fractures for the health care system [ 1 – 3 ]. The increasingly aging society in Germany and the higher prevalence of osteoporosis in old age depict two driving factors of the increasing prevalence of this fracture type [ 1 , 4 ].…”

“…A doubling from 1990 to 2025, and a further doubling to 2050 was predicted [ 5 ]. Based on the epidemiological data in Germany, a significant increase in FNF rate between 1.0 and 2.3% per year can be expected [ 1 , 3 , 6 ].…”

“…Current data from Germany show that the vast majority of FNF are treated by HA. In most cases, the femoral fixation option using cementation is used [ 3 ]. Okike et al already showed that fewer aseptic revision procedures need to be performed after cemented anchorage of partial arthroplasties, while no significant differences between the two fixation techniques were found for both in-hospital mortality and 1-year mortality in the USA [ 12 ].…”

The Modified Spare Piriformis and Internus, Repair Externus Approach for Hip Arthroplasty

“…The incidence of intracapsular neck of femur (NOF) fractures continues to rise worldwide [1]. Total hip replacement (THR) is recommended for patients who are independently mobile, have no cognitive impairment, and are fit for anaesthesia.…”