Abstract

A questionnaire survey was set up in Denmark in 1996 including 40 orthopedic departments and 20 departments of general surgery, all dealing with the treatment of intracapsular fractures of the femoral neck. The aim of the survey was to investigate whether the treatment of these complex fractures in Denmark followed the international standard, the "gold standard", recommended in the recent international literature. A shift in the treatment was noted, as compared with an earlier questionnaire survey in 1988, with more orthopedic departments performing a graduated treatment with respect to the age of the patients and fracture grade (Garden class). That is: a) nondisplaced fractures, b) displaced fractures (b.1 below 75 years and b.2 above 75 years). Cannulated screws/pins were more commonly used in Garden I and II fractures (non displaced fractures) and in Garden III and IV fractures (displaced fractures) in patients below 75 years. Hemiarthroplasty/arthroplasty were more commonly used in the older age group, above 75 years, in displaced fractures (Garden III-IV). It is concluded that a shift in the treatment of these fractures has occurred, especially in orthopedic departments. One reason for this may be an increasing number of orthopedic specialists with experience in arthroplastic surgery, making it possible to perform and/or supervise younger surgeons in this procedure. Another reason must be an increasing awareness among orthopedic specialists in Denmark that complication rates in osteosynthesis of the displaced fractures (Garden III-IV) have been too high.