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Hip and Femur

Session: ITCF Podium Session II: Geriatric Fractures

Femoral Neck Fracture Care in Latin America

Wednesday, October 18, 2023
10:43 AM – 10:49 AM PST
Location: 608-609
Purpose: The incidence of hip fractures continues to increase throughout Latin America. Despite this, there are few studies that assess hip fracture management in the region, impeding efforts to develop cost-effective solutions for this growing problem. This study seeks to evaluate femoral neck fracture management from surgeon experts in the region.

Methods: A survey, based on input from Latin American orthopaedic traumatologists, was developed and administered via REDCap using a snowball survey design. One surgeon leader per Latin American country (n = 12) identified 10 surgeons in their country who could potentially meet a list of “expert” criteria that included: (1) ≥10 years in practice as an orthopaedic surgeon; (2) holding a leadership position on a local (hospital), regional (academic or clinical), or national (academic or clinical) level; (3) treating traumatic musculoskeletal injuries at least 50% of their practice; and (4) completing ≥500 hip fracture cases annually as the primary surgeon. Experts identified 108 potential leaders, who were subsequently sent the survey. Descriptive statistics and Fisher’s exact tests were performed using STATA 15.

Results: 78 surgeons responded to the survey, yielding a response rate of 72%, of whom 44 surgeons met the inclusion criteria. Among the findings for preoperative care, most surgeons reported utilizing pre-traction for femoral neck fractures (84%) and administering prophylactic antibiotics (95%), which were largely first-generation cephalosporins (88%) administered prophylactically less than 1 h before surgery (62%). Surgical delays varied by fixation type, with total hip arthroplasty having the longest delays (70% ≥24 hours), followed by hemiarthroplasty (65% ≥24 hours) and internal fixation (34% ≥24 hours). Further, there were significant differences in the administration of prophylactic antibiotics (P = 0.022) and timing of antibiotic administration (P = 0.002) reported across countries in this region.

Conclusion: Understanding existing treatment patterns for hip fracture care is critical for developing standards and addressing areas for needed improvements. While there were common patterns of management, this study demonstrated a variety of differences in critical aspects of care by recognized experts across Latin America. These results will guide additional future studies on hip fracture management and will aid in the development of best practice recommendations, identification of differences in treatments, and targeting of interventions to address gaps in care in the region.