Trends in management of neck of femur fracture.

OBJECTIVE To identify trends related to surgical procedure for the management of neck of femur fracture to see how the choice is changing over time in relation to different age groups. METHODS The retrospective audit was conducted at Aga Khan University Hospital, Karachi, and comprised data of all patients who presented with neck of femur fracture from 1995 to 2014. Patients with open fractures and those having external fixators were excluded. Data was retrieved from the hospital database, and analysed using SPSS 17. RESULTS Records of 1039 patients were reviewed. The proportion of patients in the 70+ years age group significantly increased from 45% to 52% over the two decades (p=0.033). Proportion of patients undergoing total hip replacement increased by more than 3 times from 2.6% to 8% (p<0.001).Internal fixation was the most common procedure in patients aged <50 (p<0.001), and hemiarthroplasty for those aged > 50 years (p<0.001). Total hip replacement was seen in its highest proportion (15%) in patients aged 40-49 years (p=0.006). Hemiarthroplasty showed a dramatic decrease in the age group 50-59 years (from 57% to 40%). Total hip replacement showed a steady increasing trend over the last 20 years, most prominently in people in their 50s and 60s (from 1% to 18%; p<0.001). CONCLUSIONS There is apparently a rising trend in number of patients presenting with neck of femur fracture. Total hip replacement has a rising trend and partial hip arthroplasties have a decreasing trend when it comes to treatment of neck of femur fractures.