Abstract
BackgroundVarious internal fixation methods have been used to treat proximal femur fractures and occasionally the fixation material is removed. However, nationwide trends of hardware removals are not known. Thus, this study investigated the hardware removal rates after proximal femur fractures in Finland during 1997–2016.Materials and methodsFinnish adults aged 18 years or older in 1997–2016 formed the basic study population. From the National Hospital Discharge Register patients with trochanteric femur fracture treated with an intramedullary nail (IMN) or dynamic hip screw (DHS), and patients with femoral neck fracture treated with screw fixation, were included. Hardware removal and secondary prosthesis rates were assessed.ResultsAltogether 41,253 patients underwent proximal femoral fracture fixation surgery in Finland in 1997–2016. Of these, 16,152 were DHS surgery and 15,724 IMN surgery and 8491 underwent screw operation of femoral neck fracture. The total removal rates of DHS and IMN were 5.5% and 5.4%. The total removal rate of screw fixations of the femoral neck was higher, 18.5%. The total removal rates during the first 3 years after the IMN more than halved in 1997–2013, from 7.6% to 3.7%, whereas the removal rate of the DHS or screw fixation of femoral neck fractures did not show consistent trend. The rate of secondary prosthesis operations following DHS and IMN was low (1.8% for both). This was in clear contrast to the prosthesis rate following screw fixations of the femoral neck (7.2%).ConclusionsIMN operations largely replaced DHS operations in trochanteric fractures of the proximal femur in Finland in 1997–2016. The removal and secondary prosthesis rates of the DHS and IMN were clearly lower than the corresponding rates after screw fixations of the femoral neck fracture.Level of evidenceIII, Epidemiologic study.
Highlights
MethodsFractures of the proximal femur are one the most common age-related fractures in older adults and in entire populations they represent the third most common fracture type after distal radius and metacarpal fractures [12]
Dynamic hip screw (DHS), and patients with femoral neck fracture treated with screw fixation, were included
The rate of secondary prosthesis operations following dynamic hip screw (DHS) and intramedullary nail (IMN) was low (1.8% for both). This was in clear contrast to the prosthesis rate following screw fixations of the femoral neck (7.2%)
Summary
Fractures of the proximal femur are one the most common age-related fractures in older adults and in entire populations they represent the third most common fracture type after distal radius and metacarpal fractures [12]. The incidence of proximal femur fractures increased rapidly till the end of 1990s, there was notable variation between different countries [12, 23, 35, 40]. The proportion of trochanter fractures from all proximal femur fractures has increased and this is especially true among older age groups [16, 33, 38, 39, 45]. Various internal fixation methods have been used to treat proximal femur fractures and occasionally the fixation material is removed. This study investigated the hardware removal rates after proximal femur fractures in Finland during 1997–2016
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