Epidemiology and treatment of proximal femoral fractures in the elderly U.S. population

Abstract

Proximal femoral fractures are a serious complication, especially for elderly patients. Detailed epidemiological analyzes provide a valuable resource for stakeholders in the health care system in order to foresee future development possibly influenceable by adaption of therapeutic procedures and prevention strategies. This work aimed at answering the following research questions: (1) What are the incidence rates of proximal femoral fractures in the elderly U.S. population? (2) What is the preferred treatment procedure for these fractures? Proximal femoral fractures occurred between January 1, 2009 and December 31, 2019 in patients ≥ 65 years were identified from the Medicare Physician Service Records Data Base. The 5% sample of Medicare beneficiaries, equivalent to the records from approximately 2.5 million enrollees formed the basis of this study. Fractures were grouped into head/neck, intertrochanteric, and subtrochanteric fractures. The overall incidence rate, age and sex specific incidence rates as well as incidence rate ratios were calculated. Common Procedural Terminology (CPT) codes were used to identify procedures and operations. In 2019, a total number of 7982 femoral head/neck fractures was recorded. In comparison to 9588 cases in 2009, the incidence substantially decreased by 26.6% from 666.7/100,000 inhabitants to 489.3/100,000 inhabitants (z = − 5.197, p < 0.001). Also, in intertrochanteric fractures, a significant decline in the incidence by 17.3% was evident over the years from 367.7/100,000 inhabitants in 2009 to 304.0 cases per 100,000 inhabitants in 2019 (z = − 2.454, p = 0.014). A similar picture was observable for subtrochanteric fractures, which decreased by 29.6% (51.0 cases per 100,000 to 35.9 cases per 100,000) over the time period (z = − 1.612, p = 0.107). Head/neck fractures were mainly treated with an arthroplasty (n = 36,301, 40.0%). The majority of intertrochanteric fractures and subtrochanteric fractures received treatment with an intramedullary device (n = 34,630, 65.5% and n = 5870, 77.1%, respectively). The analysis indicated that the incidence of all types of proximal femoral neck fractures decreased for the population of elderly patients in the U.S. within the last decade. Treatment of head and neck fractures was mainly conducted through arthroplasty, while intertrochanteric and subtrochanteric fractures predominantly received an intramedullary nailing.

Relationship between preoperative hemoglobin levels and length of stay in elderly patients with hip fractures: A retrospective cohort study

“…associated with higher rates of mortality and disability, [6][7][8][9] and the associated socio-medical costs are increasing. [10,11] In China, the direct healthcare costs related to hip fractures are expected to reach 15 billion dollars by 2025, nearly double compared to 2018. [12] Currently, the primary therapy for this disease is surgery, [13] but recuperation usually requires a longer length of stay (LOS) for patients.…”

Trends in Hospital Stay, Complication Rate, and Mortality in Hip Fracture Patients: A Two-Decade Comparison at a National Tertiary Referral Center

“…As the population ages and the frequency of hip fractures increases, these financial burdens are predicted to increase [14]. Recent literature reported that the age-adjusted incidence of proximal femoral fractures has resulted in a plateau or decline in absolute numbers since the turn of the century [2,8,15]. However, with an increase in life expectancy, and as the size of the population older than 80 years grows, the number of proximal femoral fracture patients is expected to increase, especially in countries entering super-aged societies [2,15,16].…”

“…Recent literature reported that the age-adjusted incidence of proximal femoral fractures has resulted in a plateau or decline in absolute numbers since the turn of the century [2,8,15]. However, with an increase in life expectancy, and as the size of the population older than 80 years grows, the number of proximal femoral fracture patients is expected to increase, especially in countries entering super-aged societies [2,15,16]. It is projected that the global number of hip fractures will reach 6.3 million per year by 2050 [17,18].…”

Comparison of the clinical efficacy of three cannulated screws with parallel distribution and inverted triangular distribution in the treatment of femoral neck fractures in the elderly

“…In recent years, with the aggravation of global aging, the incidence of hip fractures in the elderly is increasing year by year, and femoral neck fractures account for >50% of hip fractures (1,2). Conservative treatment of femoral neck fractures in the elderly has increased risk of complications and high mortality, which seriously affects the quality of life of patients.…”