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Large Joints Feature

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Femoral Neck Fractures in Elderly Are Decreasing!

Elizabeth Hofheinz, M.P.H., M.Ed. • Fri, November 24th, 2017

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Whew…some good news for a change.

According to work from researchers at Cedars-Sinai in Los Angeles, California, femoral neck fractures in the geriatric population are actually declining. Their work, “Nationwide Analysis of Femoral Neck Fractures in Elderly Patients: A Receding Tide,” appears in the November 15, 2017 edition of The Journal of Bone & Joint Surgery.

Derek Ju, M.D., orthopedic surgeon at Cedars-Sinai and study co-author, told OTW, “Femoral neck fractures are one of the most common and disabling injuries orthopedic surgeons encounter in the elderly population. Given the aging population in the U.S., there has been a perception of an impending geriatric hip fracture epidemic.”

“First, we wanted to document the trend of femoral neck fractures in the U.S. to see if this perception was true. We have well-established surgical treatments for this injury (pinning, hemiarthroplasty, total hip arthroplasty), but the choice of surgeries can be determined on multiple factors such as surgeon choice and patient functional status. We were interested in seeing how patients across the country were being treated, and document any notable trends over the last decade.”

“We were able to utilize data from the Nationwide Inpatient Sample (NIS) database, which is the largest all-payer inpatient database available in the U.S. We thought this would be a good utilization of ‘big data’ in medicine, and we worked with an experienced biostatistician to evaluate the results and control for cofounders.”

“Over the 10-year study period, the total number and population rate of femoral neck fractures in the elderly declined significantly. Hospital costs remained relatively stable for all treatment groups when adjusted for inflation. There was a modest but significant increase in the relative utilization of total hip arthroplasty in acute femoral fracture care. Total hip arthroplasty is associated with significantly higher initial hospital costs and incidence of transfusions, but also has a decreased requirement for discharge to subacute care facilities.”

“Surgeons treating patients with acute displaced femoral neck fractures should be familiar with the recent literature supporting total hip arthroplasty in younger, active patients.”

“This trend runs counter to the perception of an impending hip fracture epidemic in the geriatric population. There is a decreasing national incidence of geriatric femoral neck fractures. In terms of surgical trends, there is an increase in the use of total hip arthroplasty to treat acute femoral neck fractures.”

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