Changing trends in the treatment of femoral neck fractures: a review of the american board of orthopaedic surgery database

Benjamin J Miller; John J Callaghan; Peter Cram; Matthew Karam; J Lawrence Marsh; Nicolas O Noiseux

doi:10.2106/JBJS.M.01122

$Changing trends in the treatment of femoral neck fractures: a review of the american board of orthopaedic surgery database$

Journal article

Peer reviewed

Changing trends in the treatment of femoral neck fractures: a review of the american board of orthopaedic surgery database

Benjamin J Miller, John J Callaghan, Peter Cram, Matthew Karam, J Lawrence Marsh and Nicolas O Noiseux

Journal of bone and joint surgery. American volume, Vol.96(17), pp.e149-e149

09/03/2014

DOI: 10.2106/JBJS.M.01122

PMID: 25187593

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Abstract

The purpose of this study was to investigate the trends in operative management of femoral neck fractures by orthopaedic surgeons applying for board certification. We queried the American Board of Orthopaedic Surgery database to identify all femoral neck fractures that had been treated and reported by candidates taking Part II of the licensing examination from 1999 to 2011 to determine the utilization of internal fixation, hemiarthroplasty, and total hip arthroplasty. The longitudinal trends were then stratified by patient age (younger than sixty-five, sixty-five to seventy-nine, eighty and older) and the declared subspecialty of the candidate. There were 19,541 femoral neck fractures that had been treated by 4450 board certification candidates. The use of total hip arthroplasty increased over time (0.7% of fractures in 1999, 7.7% in 2011, p < 0.001); use of hemiarthroplasty (67.1% in 1999, 63.1% in 2011, p = 0.020) and internal fixation (32.2% in 1999, 29.2% in 2011, p = 0.064) declined slightly. All geographic regions showed an increase in utilization of total hip arthroplasty, with substantial variation between locations. The proportion of patients younger than age sixty-five who were managed with total hip arthroplasty increased from 1.4% to 13.1% (p < 0.001). Candidates with a declared subspecialty of "adult reconstruction" showed a strong trend toward the use of total hip arthroplasty (4.3% from 1999 to 2002, 21.1% from 2009 to 2011, p < 0.001), while "trauma" subspecialty candidates demonstrated decreasing utilization of internal fixation (40.9% from 1999 to 2002, 32.9% from 2009 to 2011, p = 0.012). The percentage of candidates treating at least one femoral neck fracture decreased from 54.8% from 1999 to 2002 to 46.3% from 2009 to 2011 (p < 0.001). 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.

Femoral Neck Fractures - diagnostic imaging

Age Factors

Arthroplasty, Replacement, Hip - trends

Risk Assessment

United States

Femoral Neck Fractures - surgery

Fracture Fixation, Internal - trends

Humans

Middle Aged

Fracture Fixation, Internal - methods

Male

Treatment Outcome

Radiography

Arthroplasty, Replacement, Hip - methods

Orthopedics

Aged, 80 and over

Specialty Boards

Female

Aged

Databases, Factual

Details

Title: Subtitle: Changing trends in the treatment of femoral neck fractures: a review of the american board of orthopaedic surgery database
Creators: Benjamin J Miller - Departments of Orthopaedics and Rehabilitation (B.J.M., J.J.C., M.K., J.L.M., and N.O.N.) and Internal Medicine (P.C.), 200 Hawkins Drive, University of Iowa, Iowa City, IA 52242. E-mail address for B.J. Miller: benjamin-j-miller@uiowa.edu
John J Callaghan - Departments of Orthopaedics and Rehabilitation (B.J.M., J.J.C., M.K., J.L.M., and N.O.N.) and Internal Medicine (P.C.), 200 Hawkins Drive, University of Iowa, Iowa City, IA 52242. E-mail address for B.J. Miller: benjamin-j-miller@uiowa.edu
Peter Cram - Departments of Orthopaedics and Rehabilitation (B.J.M., J.J.C., M.K., J.L.M., and N.O.N.) and Internal Medicine (P.C.), 200 Hawkins Drive, University of Iowa, Iowa City, IA 52242. E-mail address for B.J. Miller: benjamin-j-miller@uiowa.edu
Matthew Karam - Departments of Orthopaedics and Rehabilitation (B.J.M., J.J.C., M.K., J.L.M., and N.O.N.) and Internal Medicine (P.C.), 200 Hawkins Drive, University of Iowa, Iowa City, IA 52242. E-mail address for B.J. Miller: benjamin-j-miller@uiowa.edu
J Lawrence Marsh - Departments of Orthopaedics and Rehabilitation (B.J.M., J.J.C., M.K., J.L.M., and N.O.N.) and Internal Medicine (P.C.), 200 Hawkins Drive, University of Iowa, Iowa City, IA 52242. E-mail address for B.J. Miller: benjamin-j-miller@uiowa.edu
Nicolas O Noiseux - Departments of Orthopaedics and Rehabilitation (B.J.M., J.J.C., M.K., J.L.M., and N.O.N.) and Internal Medicine (P.C.), 200 Hawkins Drive, University of Iowa, Iowa City, IA 52242. E-mail address for B.J. Miller: benjamin-j-miller@uiowa.edu
Resource Type: Journal article
Publication Details: Journal of bone and joint surgery. American volume, Vol.96(17), pp.e149-e149
DOI: 10.2106/JBJS.M.01122
PMID: 25187593
NLM abbreviation: J Bone Joint Surg Am
ISSN: 0021-9355
eISSN: 1535-1386
Publisher: Journal of Bone and Joint Surgery Incorporated; United States
Language: English
Date published: 09/03/2014
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation; Internal Medicine
Record Identifier: 9984040360502771

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