Secondary Logo

Institutional members access full text with Ovid®

Clinical Practice Guidelines in Action

Differences in Femoral Neck Fracture Management by Trauma and Arthroplasty Training

Stambough, Jeffrey B., MD; Nunley, Ryan M., MD; Spraggs-Hughes, Amanda G., MA; Gardner, Michael J., MD; Ricci, William M., MD; McAndrew, Christopher M., MD, MSc

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: April 15, 2019 - Volume 27 - Issue 8 - p 287–294
doi: 10.5435/JAAOS-D-17-00760
Research Article
SDC

Introduction: The purpose of this study was to survey trauma and arthroplasty surgeons to investigate associations between subspecialty training and management of geriatric femoral neck fractures and to compare treatments with the American Academy of Orthopaedic Surgeons clinical practice guidelines.

Methods: Five hundred fifty-six surgeons completed the online survey consisting of two sections: (1) surgeon demographics and (2) two geriatric hip fracture cases with questions regarding treatment decisions.

Results: In both clinical scenarios, arthroplasty surgeons were more likely than trauma surgeons to recommend total hip arthroplasty (THA) (case 1: 96% versus 84%; case 2: 29% versus 10%; P ≤ 0.02) and spinal anesthesia (case 1: 70% versus 40%; case 2: 62% versus 38%; P < 0.01). Surgeons who have made changes based on clinical practice guidelines (n = 96; 21% of surveyed) cited more use of THA (n = 56; 58% of respondents) and cemented stems (n = 28; 29% of respondents).

Conclusion: Arthroplasty surgeons are more likely to recommend THA over hemiarthroplasty and have a higher expectation for spinal anesthesia for the management of geriatric femoral neck fractures.

From the Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR (Dr. Stambough), the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO (Dr. Nunley, Ms. Spraggs-Hughes, and Dr. McAndrew), the Department of Orthopedic Surgery, Stanford University, Redwood, CA (Dr. Gardner), and the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Ricci).

Correspondence to Dr. Stambough: Jeffrey.stambough@gmail.com

Dr. Stambough or an immediate family member serves as a board member, owner, officer, or committee member of the American Association of Hip and Knee Surgeons. Dr. Nunley or an immediate family member has received royalties from MicroPort; serves as a paid consultant to Biocomposites, Cardinal Health, DePuy Synthes, Halyard Health, Medical Compression Systems, Medtronic, MicroPort, Mirus Solutions, and Smith & Nephew; has received research or institutional support from Zimmer Biomet, DePuy Synthes, Medical Compression Systems, Smith & Nephew, and Stryker; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the American Association of Hip and Knee Surgeons, the Hip Society, the Mid-America Orthopaedic Association, the Missouri State Orthopaedic Association, the Southern Orthopaedic Association, and the Knee Society. Dr. Gardner or an immediate family member has received royalties from DePuy Synthes; is a member of a speakers' bureau or has made paid presentations on behalf of KCI; serves as a paid consultant to Biocomposites, BoneSupport AB, Conventus, Globus Medical, KCI, Pacira Pharmaceuticals, SI-Bone, Stabiliz Ortho, and DePuy Synthes; has stock or stock options held in Conventus and Imagen Technologies; has received research or institutional support from Medtronic, Smart Devices, SMV Medical, DePuy Synthes, and Zimmer Biomet; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Association, the Orthopaedic Research Society, and the Orthopaedic Trauma Association. Dr. Ricci or an immediate family member has received royalties from MicroPort and Smith & Nephew; serves as a paid consultant to Smith & Nephew and Zimmer Biomet; has received research or institutional support from Smith & Nephew and DePuy Synthes; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Cable Fix, McGinley Orthopaedics, and SMV Recon; and serves as a board member, owner, officer, or committee member of the Orthopaedic Trauma Association. Dr. McAndrew or an immediate family member serves as a paid consultant to Zimmer Biomet. Ms. Spraggs-Hughes nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

© 2019 by American Academy of Orthopaedic Surgeons
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website