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Introduction <p>Transcervical femoral neck fractures (TFNFs) are among the most devastating fragility fractures in the&#xa0;elderly. TFNF are associated with excess 1-year mortality rates ranging from 15% to 30%. Treatments include conservative methods, internal fixation, and arthroplasty (partial or total hip arthroplasty). This study aims to analyze the changes in incidences of TFNF in the Italian population between 2001 and 2023 and the evolution of the choices of treatment.</p> Materials and methods <p>Using hospital discharge record (HDR) data from 2001 to 2023, records with ICD9-CM codes for femoral neck fractures (820.0 and 820.1) among diagnoses were selected and categorized into four treatment groups: total&#xa0;arthroplasty,&#xa0;partial arthroplasty, fixation, and conservative. Time series were analyzed with stratification by sex and age.</p> Results <p>The extracted data included 1,120,724 records of TFNFs, with 871,161 cases treated surgically (total or partial arthroplasty or internal fixation) and 249,563 treated conservatively; the average patient age was 79.1&#xa0;years, with a higher proportion of women (72.8%). Partial hip arthroplasty was the preferred treatment overall. For younger patients, in the age classes &lt; 45 and 45–54 years, fixation was the most chosen treatment. Over time, the use of the conservative treatment decreased from 27.5% in 2001 to 14.6% of cases in 2023. The use of partial and total hip arthroplasty increased from 40% and 13.3% in 2001 to 44.5% and 24.3% in 2023, respectively.</p> Conclusions <p>Over the past two decades, Italy experienced declining age-adjusted incidence rates of TFNF despite persistent crude numbers (approximately 50,000 cases per year) owing to demographic aging. Partial hip arthroplasty (PHA) remained the preferred treatment, while total hip arthroplasty (THA) went from being the least used to the second-most performed treatment through the 23 observed years.</p> <p><i>Level of evidence</i> level 1, population-based study</p>

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Incidence rates and treatment of the transcervical fracture of the neck of femur in Italy: is total hip arthroplasty an increasingly preferred approach? A population study on trends between 2001 and 2023 based on 1,120,770 hospital discharge records

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  • 发表日期：

    2026年3月14日

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  • Enrico Ciminello,
  • Emilio Romanini,
  • Michele Venosa,
  • Gianpiero Cazzato,
  • Gabriele Tucci,
  • Filippo Boniforti,
  • Luca Carpanese,
  • Adriano Cuccu,
  • Tiziana Falcone,
  • Paola Ciccarelli,
  • Stefania Ceccarelli,
  • Marina Torre

摘要

Introduction

Transcervical femoral neck fractures (TFNFs) are among the most devastating fragility fractures in the elderly. TFNF are associated with excess 1-year mortality rates ranging from 15% to 30%. Treatments include conservative methods, internal fixation, and arthroplasty (partial or total hip arthroplasty). This study aims to analyze the changes in incidences of TFNF in the Italian population between 2001 and 2023 and the evolution of the choices of treatment.

Materials and methods

Using hospital discharge record (HDR) data from 2001 to 2023, records with ICD9-CM codes for femoral neck fractures (820.0 and 820.1) among diagnoses were selected and categorized into four treatment groups: total arthroplasty, partial arthroplasty, fixation, and conservative. Time series were analyzed with stratification by sex and age.

Results

The extracted data included 1,120,724 records of TFNFs, with 871,161 cases treated surgically (total or partial arthroplasty or internal fixation) and 249,563 treated conservatively; the average patient age was 79.1 years, with a higher proportion of women (72.8%). Partial hip arthroplasty was the preferred treatment overall. For younger patients, in the age classes < 45 and 45–54 years, fixation was the most chosen treatment. Over time, the use of the conservative treatment decreased from 27.5% in 2001 to 14.6% of cases in 2023. The use of partial and total hip arthroplasty increased from 40% and 13.3% in 2001 to 44.5% and 24.3% in 2023, respectively.

Conclusions

Over the past two decades, Italy experienced declining age-adjusted incidence rates of TFNF despite persistent crude numbers (approximately 50,000 cases per year) owing to demographic aging. Partial hip arthroplasty (PHA) remained the preferred treatment, while total hip arthroplasty (THA) went from being the least used to the second-most performed treatment through the 23 observed years.

Level of evidence level 1, population-based study