Background: Hip fractures occur in 280,000 North Americans each
year. Although surgeons have reached consensus with regard to the treatment of
undisplaced fractures of the hip, the surgical treatment of displaced
fractures remains controversial. Identifying surgeons' preferences in
techniques, and the rationale for their choices, may aid in focusing
educational activities to the orthopaedic community as well as planning future
clinical trials. Our objective was to clarify current opinion with regard to
the operative treatment of displaced fractures of the femoral neck.
Methods: We used a cross-sectional survey design and a
sample-to-redundancy strategy to examine surgeons' preferences in the
treatment of displaced femoral neck fractures. We mailed this survey to
members of the Orthopaedic Trauma Association and European-AO
International-affiliated trauma centers.
Results: Of 442 surgeons who received the questionnaire, 298 (67%)
responded. The typical respondent was a North American man over the age of
forty years who was in academic practice, supervised residents, had fellowship
training in trauma, and worked in a low-volume center (<100 hip fractures
per year), treating an equal proportion of displaced and undisplaced femoral
neck fractures. Most surgeons believed that internal fixation was the
procedure of choice in younger patients (those who are less than sixty years
old) with a displaced fracture (Garden type III or IV). For patients over
eighty years old with Garden type-III or IV fractures, almost all surgeons
preferred arthroplasty. Respondents varied widely in their preferences for the
treatment of patients who were sixty to eighty years old with a displaced
fracture (Garden type III or IV) or active patients with a Garden type-III
fracture. Many surgeons believed there was no difference between arthroplasty
and internal fixation when considering mortality (45%), infection rates (30%),
and quality of life (37%). Surgeons also revealed variable preferences in
their choice of the optimal approach to arthroplasty for patients between
sixty and eighty years old with a type-IV fracture (32% preferred unipolar;
41%, bipolar; and 17%, total hip arthroplasty) and in the optimal choice of
implant for internal fixation.
Conclusions: While surgeons prefer internal fixation for younger
patients and arthroplasty for older patients, they disagree about the optimal
approach to the management of patients between sixty and eighty years old with
a displaced fracture and active patients with a Garden type-III fracture.
Surgeons also disagree on the optimal implants for internal fixation or
arthroplasty.