Management preferences for hip fracture care in Latin America

Despite an increase in hip fractures in Latin America, few studies have assessed management of these injuries in this region, impeding efforts to understand current treatment patterns, highlight knowledge deficits, or develop best practice guidelines. This study sought to determine current practices in hip fracture management reported by surgeon-experts in Latin America.

Based on input from a panel of Latin American orthopaedic traumatologists, a case-based survey evaluating hip fracture management preferences was developed and distributed using a snowball sampling method. One surgeon-leader per Spanish- and Portuguese-speaking Latin American country identified ≤10 surgeons experienced in treating hip fractures.

A total of 124 respondents from 16 countries completed the survey. For femoral neck fractures, internal fixation of any kind was the most reported method for nondisplaced fractures, except for patients >80 years old and unhealthy. Multiple screws were the most commonly reported internal fixation device for nondisplaced fractures across all age groups. For displaced femoral neck fractures, arthroplasty was the most reported treatment in all scenarios, except for patients <65 years old and healthy, in which internal fixation predominated. For intertrochanteric fractures, a short cephalomedullary nail was the most reported fixation method in all scenarios, particularly for patients <65 years old with unstable fractures who were healthy and community ambulators. For stable intertrochanteric fractures, a sliding hip screw was the second most reported fixation method. In unstable fracture patterns, a long cephalomedullary nail was the second most commonly reported fixation method. The use of arthroplasty for intertrochanteric fractures generally increased with patient age and was most commonly used in patients >80 years old with an unstable fracture who were unhealthy and minimal/nonambulators. Postoperatively, non-weight bearing was most often preferred for unstable fractures treated with internal fixation, and full weight bearing was commonly recommended for stable fractures treated with arthroplasty. Most respondents considered fracture pattern, patient age, preoperative function and quality of life, and quality of reduction as the most important factors when choosing between fixation and arthroplasty.

The findings from this study established foundational knowledge on hip fracture management and will be used to ultimately develop recommendations and targeted interventions in hip fracture care in Latin America.

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