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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Geographic variation in device use for intertrochanteric hip fractures
Mary L Forte1, Beth A Virnig, Robert L Kane
1Division of Health Policy and Management, School of Public Health, University of Minnesota, MMC 197, D351 Mayo, 420 Delaware Street S.E., Minneapolis, MN 55455, USA. fort0023@umn.edu
The Journal of Bone and Joint Surgery. American Volume
|April 3, 2008
Summary
Geographic variation in intramedullary nailing for hip fractures among Medicare patients was substantial between 2000-2002. Patient factors did not explain these differences in treatment methods for intertrochanteric fractures.
Area of Science:
- Orthopedic surgery
- Geriatric medicine
- Health services research
Background:
- Hip fractures are a significant health issue in the elderly population.
- Intertrochanteric fractures constitute nearly half of all hip fractures.
- Current treatments include plate-and-screw devices and intramedullary nails.
Purpose of the Study:
- To assess geographic variations in intramedullary nail use for intertrochanteric fractures.
- To analyze trends in treatment methods among Medicare beneficiaries from 2000 to 2002.
Main Methods:
- Analysis of Medicare 100% files (hospital, physician claims, enrollment) for beneficiaries aged 65+.
- Inclusion of inpatient surgeries for intertrochanteric femoral fractures treated with plate-and-screw or intramedullary nail devices.
- Logistic regression modeling to adjust for patient demographics, comorbidities, and Medicaid status.
Main Results:
- Over 212,000 claims were analyzed for intertrochanteric fractures between 2000-2002.
- Significant geographic disparities in intramedullary nail utilization were observed across states.
- The national rate of intramedullary nailing increased from 7.84% in 2000 to 16.98% in 2002.
Conclusions:
- Substantial geographic variation in intramedullary nailing for intertrochanteric fractures existed from 2000-2002.
- These variations were not adequately explained by patient-specific factors.
- Further research is needed to understand the drivers of these treatment disparities.
