Femoral Neck Fractures: Controversies and Evidence

Hip fractures occur in 280,000 Americans (over 5000 per week) and 36,000 (over 690 per week) Canadians annually. By the year 2040, the number of people aged 65 years or older will increase from 34.8 to 77.2 million. The number of hip fractures is likely to exceed 500,000 annually in the United States and 88,000 in Canada over the next 40 years.1-3 By the year 2040, the estimated annual health care costs will reach a staggering $9.8 billion in the United States and $650 million in Canada. Hip fractures are associated with a 30% mortality rate and profound temporary and sometimes permanent impairment of independence and quality of life. Worldwide, 4.5 million persons are disabled from hip fractures yearly with an expected increase to 21 million persons living with disability in the next 40 years. Furthermore, approximately 30% of surgically treated hip fractures require revision surgery. These revisions are associated with a large burden of morbidity and mortality. The disability-adjusted life years lost as a result of hip fractures ranks in the top 10 of all causes of disability globally.1 An evidence-based approach to management of patients with hip fractures will improve outcomes and may reduce costs. In this issue of the Journal of Orthopaedic Trauma, we have adopted an evidence-based approach to the management of patients with hip fractures. We have evaluated perioperative considerations, implants used for treatment, complications, postoperative considerations, use of bone substitutes, pharmaceuticals, and other adjuncts as well as various outcome measures used for assessment. The information presented herein provides important information for clinical practice. We conclude by noting that there are still many controversies in hip fracture care and that these ultimately will require large global collaborative trials to obtain the answers to these important questions.