ilii Iiz.structiona / Course Lecture, The Aniericati Acadenzv of Orthopaedic Surgeons

The worldwide prevalence of fractures of the proxi-mal part of the femur is increasing as the average age of the population increases. The actual number of these fractures in the United States doubled from the mid-1960’s through the 1980’s. Frandsen and Kruse predicted that the number of such fractures will triple that of today by the year 2050. Thus. fractures of the proximal part of the femur are an important cause of morbidity and mor-tality in all age-groups, especially the elderly. Approximately 250,000 fractures of the proximal part of the femur occur in the United States each year. resulting in annual health-care costs of more than 8.7 billion dollars75. Extensive debate continues with regard to the cost-effectiveness of various medical and opera-tive therapies. including the treatment of fractures of the proximal part of the femur. Using the concept of quality-adjusted life-years, Parker et al. determined that operative treatment is the most cost-effective approach for displaced intracapsular fractures and all extracapsu-lar fractures75. Thus, the proper treatment of fractures of the proximal part of the femur is important not only for the continued health and vitality of the population but also for the health of the economy. Fractures of the proximal part of the femur occur predominantly as low-energy injuries in elderly patients and as high-energy injuries in younger patients. The high prevalence of these fractures in the elderly is related to numerous factors, including osteoporosis, malnutrition, decreased physical activity, impaired vision, neurologi-cal impairment, poor balance, altered reflexes, and mus-cular weakness. Firooznia et al. showed. however. that elderly patients who sustained fractures of the proximal part of the femur did not have a higher rate of osteopo-rosis than age-matched control subjects32. Fractures of the proximal part of the femur in el