Trends in Surgical Management of Femoral Neck Fractures in the United States
- First Online:
- 214 Downloads
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.
- 1.Agency for Healthcare Research and Quality. Available at: http://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp. Accessed June 1, 2008.
- 2.Agency for Healthcare Research and Quality. HCUP Quality Control Procedures. Available at: http://www.ahrq.gov/data/hcup/sasddocu/techsupp2.pdf. Accessed June 1, 2008.
- 5.Bhandari M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, Schemitsch EH, Hanson BP, Koval K, Dirschl D, Leece P, Keel M, Petrisor B, Heetveld M, Guyatt GH. Operative management of displaced femoral neck fractures in elderly patients: an international survey. J Bone Joint Surg Am. 2005;87:2122–2130.PubMedCrossRefGoogle Scholar
- 6.Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br. 2007;89:160–165.PubMedCrossRefGoogle Scholar
- 12.Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2001;83:1622–1629.PubMedCrossRefGoogle Scholar
- 13.Katz JN, Phillips CB, Baron JA, Fossel AH, Mahomed NN, Barrett J, Lingard EA, Harris WH, Poss R, Lew RA, Guadagnoli E, Wright EA, Losina E. Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery. Arthritis Rheum. 2003;48:560–568.PubMedCrossRefGoogle Scholar
- 23.Whalen D, Houchens R, Elixhauser A. Final 2000 NIS Comparison Report. HCUP Methods Series Report #2003-1. Agency for Healthcare Research and Quality. Available at: http://www.hcup-us.ahrq.gov/reports/2000NISComparisonReportFinal.pdf. Accessed June 1, 2008.