title: Operative management of displaced femoral neck fractures in elderly patients. An international survey.
abstract: 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.
authors.affiliation: Department of Surgery, Hamilton Health Sciences-General Hospital, 237 Barton Street East, 7 North, Suite 727, Hamilton, Ontario L8L 2X2, Canada. bhandam@mcmaster.ca
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Marc F
authors.initials: MF
authors.lastname: Swiontkowski
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Berry
authors.forename: George
authors.initials: G
authors.lastname: Haidukewych
authors.forename: Emil H
authors.initials: EH
authors.lastname: Schemitsch
authors.forename: Beate P
authors.initials: BP
authors.lastname: Hanson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Koval
authors.forename: Douglas
authors.initials: D
authors.lastname: Dirschl
authors.forename: Pamela
authors.initials: P
authors.lastname: Leece
authors.forename: Marius
authors.initials: M
authors.lastname: Keel
authors.forename: Brad
authors.initials: B
authors.lastname: Petrisor
authors.forename: Martin
authors.initials: M
authors.lastname: Heetveld
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D001208:Asia; D003430:Cross-Sectional Studies; D005060:Europe; D005265:Femoral Neck Fractures / Q000473:pathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods; D019538:Health Care Surveys; D006801:Humans; D016268:Internal Fixators; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009656:North America; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome