Regional differences and trends in treatment approaches for femoral neck fractures in Finland: A nationwide analysis.

Abstract

Background and aims: Femoral neck fractures represent a major health concern in aging populations due to their morbidity and mortality. Although operative treatment is the standard, regional and temporal variations in surgical approaches exist. This study evaluates nationwide trends in the treatment of femoral neck fractures in Finland from 1997 to 2018.

Methods: Data from the Finnish National Hospital Discharge Register were analyzed for 75,043 skeletally mature patients undergoing primary surgery for acute femoral neck fractures. Surgical methods-internal fixation, cemented and cementless hemiarthroplasty, and total hip arthroplasty-were assessed across 21 hospital districts. Trends in treatment choices, hospital stays, surgical delays, and demographics were analyzed using the Mann-Kendall test.

Results: Treatment patterns demonstrated a clear shift toward cemented hemiarthroplasty, in line with evolving clinical guidelines. The use of total hip arthroplasty increased in northern regions. Internal fixation remained more common in selected regions, ranging from 13.6% to 66% across hospital districts, despite an overall decline in use. The proportion of short hospital stays (0-3 days) increased by 31.5% during the study period. Surgical delays also improved, as evidenced by a reduction of 15.3% in the proportion of patients waiting 2 or more days for surgery. Patients undergoing total hip arthroplasty continued to experience the longest delays (a total of 39.7% for 2+ day delays). The overall incidence of surgically treated femoral neck fractures decreased in almost all regions.

Conclusion: Over two decades, treatment of femoral neck fractures in Finland has evolved, with shorter hospital stays and reduced surgical delays. However, significant regional differences in surgical approaches persist, highlighting the need for more consistent national treatment protocols. Further research is warranted to understand the drivers of these variations and their impact on outcomes.