The increasing complexity of femoral fragility fractures: incidence, fracture patterns and management over a 10-year period.

INTRODUCTION: The purpose of this study was to determine whether there have been changes in the numbers and complexity of femoral fragility fractures presenting to our department over a period of 10 years. METHODS: Patients >60 years presenting with femoral fragility fractures to our institution in 2018-2019 (397 fractures) were compared with respect to demographic data, incidence rates, fracture classification and surgical management with a historical cohort from 2009-2010 (335 fractures). Pathological and high velocity fractures were excluded. RESULTS: The gender proportion and average age (83.1 vs. 82.7 years) was unchanged. The number of femoral fractures increased by 19% but the overall incidence in people >60 years fell by 6% (p = 0.41). The proportion of unstable trochanteric fractures (31A2 and A3) increased from 22% to 55% (p < 0.001). The proportion of displaced intracapsular fractures increased from 53% to 72% (p < 0.001). The incidence of stable trochanteric fractures fell from 12.4 to 7.3/10,000 patients>60 years (p = 0.0006) while the incidence of unstable trochanteric fractures (31A2 and 31A3) increased from 3.5 to 8.9/10,000 patients >60 years (p < 0.0001). The proportion of trochanteric fractures treated with an intramedullary (IM) nail increased from 9% to 35% (p = 0.0001). The number of shaft and distal femoral fractures increased by 41% although the incidence did not change significantly. Periprosthetic fractures comprised 70% of femoral shaft fractures in both cohorts. CONCLUSIONS: The increasing number and complexity of femoral fragility fractures, especially unstable trochanteric fractures and periprosthetic fractures, is likely to have an impact on implant use, theatre time and cost.

Postcode osteoarthritis: geographic inequities in hip and knee arthroplasty.

BACKGROUND: It is suspected that there are differences in access to orthopaedic care within New Zealand (NZ), due to inter-hospital differences in scoring thresholds for surgical eligibility. We aimed to evaluate those patients who meet the threshold for publicly funded surgery with regard to both functional disability and severity of radiographic arthritis across three different public hospitals to assess any discrepancies. METHODS: A retrospective review of prospectively collected data over a 12 month period (2018-2019) across three public hospitals (Auckland City, North Shore and Whangarei hospitals) in NZ was performed. Patients undergoing primary hip and knee arthroplasty for OA were eligible for the study. Preoperative Oxford Score and the Tonnis and Kellgren-Lawrence classification systems for hip and knees, respectively, were compared. RESULTS: A total of 274 scheduled total arthroplasties (161 hips and 113 knees) in 273 patients were included for analysis. The mean Preoperative Oxford scores for individuals with hip OA in Auckland, North Shore and Whangarei were 15.9 (SD 10.5), 14.5 (SD 6.9) and 11.9 (SD 5.7), respectively. The mean Preoperative Oxford scores for individuals with knee OA in Auckland, North Shore and Whangarei were 17.4 (SD 11.9), 18.2 (SD 6.2) and 12.7 (SD 6.9), respectively. CONCLUSION: Patients undergoing hip and knee joint replacement surgery in Whangarei hospital are, on average, more functionally impaired and have more severe radiographic arthritis than those having the same proposed surgery in Auckland and North Shore hospitals.