Kingery Matthew T, Lezak Bradley A, Lin Charles C, Anil Utkarsh, Bosco Joseph
From the NYU Langone Orthopedic Hospital, New York, NY.
J Am Acad Orthop Surg. 2025 May 15;33(10):535-541. doi: 10.5435/JAAOS-D-24-00750. Epub 2025 Mar 21.
Femoral neck fractures pose a notable health challenge globally, with a projected rise in cases due to aging populations. While treatment protocols are established, the effect of surgeon training on treatment decisions, particularly trauma versus arthroplasty fellowship training, remains less clear.
This study, using data from the Statewide Planning and Research Cooperative System in New York State, examined 26,761 patients meeting inclusion criteria. Among 951 treating surgeons, 20.6% had no subspecialty fellowship training while 4.6% had training in multiple subspecialties, with arthroplasty (232 surgeons, 24.4%), sports (230 surgeons, 24.2%), and trauma (93 surgeons, 9.8%) being the most common.
Analysis revealed notable differences in surgical treatments based on subspecialty, with trauma surgeons favoring fixation and arthroplasty surgeons favoring total hip arthroplasty (THA). Even after adjusting for covariates, patients treated by arthroplasty-trained surgeons were more likely to receive THA. In addition, there was consistency between trauma and arthroplasty surgeons in treating lower functional demand patients with hemiarthroplasty. While trauma surgeons performed more fixations and arthroplasty surgeons more THAs, baseline characteristics and perioperative outcomes between fixation and THA patients were similar, indicating comparable baseline health despite treatment differences. Multivariable logistic regression confirmed that treatment by an arthroplasty surgeon markedly increased the odds of receiving THA.
This study underscores the complexity added by surgeon subspecialty in femoral neck fracture management and emphasizes the importance of recognizing how surgeon-specific factors influence treatment decisions. Understanding these nuances can inform training optimization and promote collaborative approaches within the orthopaedic community, ultimately contributing to enhanced patient outcomes as femoral neck fracture management evolves.
股骨颈骨折在全球范围内构成了显著的健康挑战，由于人口老龄化，预计病例数将会增加。虽然已经制定了治疗方案，但外科医生培训对治疗决策的影响，尤其是创伤与关节成形术专科培训的影响，仍不太明确。
本研究利用纽约州全州规划与研究合作系统的数据，对26761名符合纳入标准的患者进行了检查。在951名治疗外科医生中，20.6%没有专科培训，4.6%接受了多个专科的培训，其中关节成形术（232名外科医生，24.4%）、运动医学（230名外科医生，24.2%）和创伤外科（93名外科医生，9.8%）是最常见的专科。
分析显示，基于专科的手术治疗存在显著差异，创伤外科医生倾向于固定治疗，关节成形术外科医生倾向于全髋关节置换术（THA）。即使在调整协变量后，接受关节成形术培训的外科医生治疗的患者接受THA的可能性仍然更高。此外，创伤外科医生和关节成形术外科医生在治疗功能需求较低的患者时采用半髋关节置换术方面保持一致。虽然创伤外科医生进行的固定手术更多，关节成形术外科医生进行的THA手术更多，但固定治疗和THA治疗患者的基线特征和围手术期结果相似，这表明尽管治疗方式不同，但基线健康状况相当。多变量逻辑回归证实，由关节成形术外科医生进行治疗显著增加了接受THA的几率。
本研究强调了外科医生专科在股骨颈骨折管理中增加的复杂性，并强调了认识到外科医生特定因素如何影响治疗决策的重要性。了解这些细微差别可为培训优化提供参考，并促进骨科领域的协作方法，最终随着股骨颈骨折管理的发展，有助于改善患者的治疗结果。
