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Trends in Surgical Management of Femoral Neck Fractures in the United States

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Clinical Orthopaedics and Related Research

Abstract

We examined trends in utilization of open reduction and internal fixation (ORIF), THA, and hemiarthroplasty (HA) for femoral neck fractures. Closed femoral neck fractures managed with ORIF or hip arthroplasty (n = 162,257) were extracted from 1990 to 2001 Nationwide Inpatient Samples. Trends were examined during three periods (1990–1993 [Period I], 1994–1997 [Period II], and 1998–2001 [Period III]). Utilization of HA increased from 67.8% in Period I to 75.3% in Period III. In the same period, utilization of THA decreased from 11.6% to 6.6%. The trend of decreased use of THA was consistent regardless of age, hospital, or surgeon volume. In Period III, 28.7% of patients were managed at urban teaching hospitals as compared with 19.6% in Period I. Increased utilization of HA conforms with recent evidence that arthroplasty has better outcomes than ORIF. However, the decrease in THA is contrary to what was expected, and its impact on patient outcomes needs to be evaluated. The increase in the proportion of femoral fractures managed at urban teaching hospitals may reflect a change in the organization of trauma systems during the last decade.

Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA, USA

    Nitin B. Jain MD, MSPH & Daniel M. Ward MD

  2. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, 125 Nashua Street, Boston, MA, 02114, USA

    Nitin B. Jain MD, MSPH

  3. Department of Medicine, Newton-Wellesley Hospital, Newton, MA, USA

    Nitin B. Jain MD, MSPH

  4. Section of Clinical Sciences, Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Boston, MA, USA

    Elena Losina PhD & Jeffrey N. Katz MD, MS

  5. Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Elena Losina PhD, Mitchel B. Harris MD & Jeffrey N. Katz MD, MS

  6. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

    Elena Losina PhD

Authors
  1. Nitin B. Jain MD, MSPH
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  2. Elena Losina PhD
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  3. Daniel M. Ward MD
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  4. Mitchel B. Harris MD
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  5. Jeffrey N. Katz MD, MS
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Corresponding author

Correspondence to Nitin B. Jain MD, MSPH.

Additional information

One or more of the authors have received funding from the Turner Fellowship (NBJ) from New England Baptist Hospital, Boston, MA and National Institutes of Health P60 AR 47782 (JNK) and National Institutes of Health K24 AR 02123 (JNK).

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Jain, N.B., Losina, E., Ward, D.M. et al. Trends in Surgical Management of Femoral Neck Fractures in the United States. Clin Orthop Relat Res 466, 3116–3122 (2008). https://doi.org/10.1007/s11999-008-0392-3

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  • DOI: https://doi.org/10.1007/s11999-008-0392-3

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