Thurs., 10/18/07 Femur, Paper #2, 1:06 pm OTA-2007
Patient Preferences for the Treatment of Displaced Femoral Neck Fractures: A Decision-Board Analysis of Internal Fixation versus Hemiarthroplasty
Janhavi Shirali (n); Bashar Alolabi, MD (n); Sohail S. Bajammal, MB, ChB, MSc (n);
Paul J. Karanicolas, MD (n); Michael Zlowodzki, MD (n); Mohit Bhandari, MD, MSc (n);
McMaster University, Hamilton, Ontario, Canada
Purpose: The optimal treatment for displaced femoral neck fractures in patients aged 60 to 80 years is controversial. Internal fixation and arthroplasty are viable alternatives with proponents for each approach. Orthopaedic surgeons who advocate for arthroplasty cite strong evidence that there is an increased revision rate with internal fixation. However, patients’ preferences for these two options are unknown.
Methods: Using standard methodology, we developed a decision board presenting descriptions, expected outcomes, and potential complications of hemiarthroplasty and internal fixation for the treatment of displaced femoral neck fractures. Five orthopaedic surgeons evaluated the face and content validity of the decision board. Construct validity was tested on 10 healthy volunteers using “scope tests”. 108 healthy volunteers were confronted with the scenario of sustaining a displaced femoral neck fracture and presented the decision board, then asked to state their preference for operative procedure and to describe the reasons for their choice.
Results: Sixty-one of 108 participants (56%) chose internal fixation over arthroplasty as their operative procedure of choice. Factors that contributed to this choice included less blood loss (61%), shorter operation time (34%), less mortality (20%), and less invasiveness (20%). Participants who preferred arthroplasty (44%) did so primarily due to the lower reoperation rate (94%).
Conclusion and Significance: Despite common surgeon preferences for arthroplasty, over half of participants preferred internal fixation due to less blood loss, shorter operative times, lower mortality, and less invasiveness. Surgeons should not assume that patients would prefer arthroplasty over internal fixation; the decision board can be an effective aid to incorporate patients’ preferences into the decision-making process.
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