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. 2008 Dec;466(12):3116-22.
doi: 10.1007/s11999-008-0392-3. Epub 2008 Jul 22.

Trends in surgical management of femoral neck fractures in the United States

Nitin B Jain  1 , Elena Losina, Daniel M Ward, Mitchel B Harris, Jeffrey N Katz
Affiliations

Trends in surgical management of femoral neck fractures in the United States

Nitin B Jain et al. Clin Orthop Relat Res. 2008 Dec.

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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Figures

Fig. 1
Fig. 1
The case inclusion schema is shown for patients with femoral neck fractures undergoing HA, THA, or ORIF. ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification.
Fig. 2
Fig. 2
Temporal trends in increased utilization of HA and decreased utilization of THA for surgical management of femoral neck fractures are shown. ORIF = open reduction and internal fixation.
See this image and copyright information in PMC

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