title: Changing trends in the treatment of femoral neck fractures: a review of the american board of orthopaedic surgery database.
abstract: BACKGROUND
  The purpose of this study was to investigate the trends in operative management of femoral neck fractures by orthopaedic surgeons applying for board certification.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Miller
authors.affiliation: 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.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
authors.affiliation: 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.
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
authors.affiliation: 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.
authors.forename: Matthew
authors.initials: M
authors.lastname: Karam
authors.affiliation: 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.
authors.forename: J Lawrence
authors.initials: JL
authors.lastname: Marsh
authors.affiliation: 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.
authors.forename: Nicolas O
authors.initials: NO
authors.lastname: Noiseux
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods / Q000639:trends*; D016208:Databases, Factual; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D011859:Radiography; D018570:Risk Assessment; D013044:Specialty Boards; D016896:Treatment Outcome; D014481:United States