Sat., 10/18/08 Femur, Paper #46, 9:15 am OTA-2008
Technical Considerations in the Surgical Management of Femoral Neck Fractures in Patients Less Than 50 Years of Age: An Expert Opinion Survey
Tania Ferguson, MD1 (n); William Page, MD1 (n); Mohit Bhandari, MD2 (n);
Ravi Patel, MD1 (n); Mark A. Lee, MD1 (a-UC Davis Department of Orthopaedic Surgery);
1University of California Davis, Sacramento, California, USA;
2McMaster University, Hamilton, Ontario, Canada
Purpose: Our objective was to identify current opinions and practice trends among orthopaedic traumatologists relating to the surgical management of femoral neck fractures in young patients (<50 years of age).
Methods: We used a cross-sectional survey design to examine surgeons’ preferences on optimal surgical timing, the importance of anatomic reduction, and the effect of operating room (OR) availability on decision making in the treatment of femoral neck fractures in young patients (<50 years). The survey was administered to 378 orthopaedic surgeons identified as experts in orthopaedic traumatology based on active membership in the Orthopaedic Trauma Association.
Results: 231 of 378 surgeons responded (61%). 79% of responding surgeons were currently taking call at Level 1 trauma centers, with an average call experience of 11 years (range, 0-35). 78% of those actively taking Level 1 call and 37% of those not taking Level 1 call had protected, daytime OR time designated for trauma available at their institutions. 74% of respondents believed time to operation influences patient outcome, yet only 17% felt the time to surgery was more important than “optimal surgical conditions.” Regarding time to operation, 37% responded that timing was very important (8-10), and 58% responded somewhat important (4-7) to patient outcome (average 6.5 ± 1.9, median 7). In contrast, 97% felt anatomic reduction was very important for patient outcome, with an average numerical score of 9.3 ± 1.1, and a median of 10. 30% of respondents felt the gold standard was to have patients in the OR within 6 hours. 24% considered 12 hours to be the maximum acceptable time delay, and 29% considered 24 hours to be acceptable. Almost half of surveyed surgeons would not start the case after 8 pm if there was a designated OR available for a guaranteed first case in the morning, and 87% indicated they would not start after midnight under these conditions. On the contrary, 56% responded they would begin the surgery regardless of time if there was not a guaranteed OR available in the morning.
Conclusions: While traditionally considered a surgical emergency, our survey demonstrates a change in opinion regarding the acceptable delay to operation in young patients with femoral neck fractures. The emergence of “trauma room” availability has potentially changed the management approach. Most agree anatomic reduction is important for outcome and that reduction takes precedence over time to operation.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.