How do orthopedic surgeons manage displaced femoral neck fracture in middle-age patients? Brazilian survey of 78 orthopedic surgeons

Abstract

Objective The aim of the present study was to evaluate the practices and preferences of Brazilian orthopedic surgeons for the treatment of femoral neck fracture in middle-aged patients. Methods A survey containing 10 images of femoral neck fractures was sent to a group of 100 orthopedic surgeons, all of them members of the Brazilian Society of Orthopedics and Traumatology. The questionnaire asked the treatment option for cases of nondisplaced and displaced fractures of the femoral neck in middle-aged patients, characterized by those aged between 50 and 69 years old. Descriptive and inferential statistical analyses were performed using the chi-squared (χ2) and the Fisher exact tests. The level of significance was 5%. Results The survey was answered by 78% of the orthopedic surgeons invited to participate in the present study. It was observed that there was no significant difference in the distribution of the treatment method between generalists and specialists (p ¼ 0.16) in the sample of nondisplaced femoral neck fractures. It was observed that there was a highly significant difference in the distribution of the treatment method between generalists and specialists (p < 0.0001) in the sample of displaced fractures of the femoral neck. Conclusion The preservation of the femoral head by means of fixation with multiple cannulated screws is the treatment of choice for nondisplaced fractures of the femoral neck for both generalists and specialists. Low chronological and/or physiological age are the main factors for this decision-making. In cases in which the femoral neck fracture is displaced, femoral head replacement is preferred for both groups of orthopedists (generalists and specialists). In this situation, the specialists prefer the total hip arthroplasty (THA) and the generalists the partial hip arthroplasty (PHA).