Management of Femoral Neck Fractures in Patients 50 Years or Older by American Board of Orthopaedic Surgery Part II Examination Candidates

Objective: Assess associations between fellowship training, procedure, and performance in femoral neck fracture (FNF) surgery on adults by American Board of Orthopaedic Surgery Part II examination candidates.Setting: American Board of Orthopaedic Surgery SCRIBE database examination years 2007-2020.Participants: Six thousand seven hundred seventy-seven candidates performing 39,283 FNF surgeries on adults 50 years or older.Intervention: Fellowship training.Main Outcome Measurements:Case volume; procedure performed: internal fixation, hemiarthroplasty, or total hip arthroplasty (THA); complications; readmission; reoperation.Results: Over the observation period, fewer candidates reported FNF surgery (68% overall, -0.6%/year, R-2 = 0.80) while more candidates reported fellowship training (87% overall, +1.4%/year, R-2 = 0.81). The rate of any complication was significantly associated with fellowship training (32% overall, P < 0.001). Readmission (12%, P = 0.080) and reoperation (5%, P = 0.531) were not significantly associated with fellowship training. The odds of any complication (odds ratio [OR] = -0.03 [95% CI, -0.07 to -0.001] per 10 cases) and surgical complication (OR = -0.12 [95% CI, -0.17 to -0.07] per 10 cases) were negatively associated with candidate FNF case volume. In total, 3,396 THA for FNF were performed (8% of cases). THA use increased 25 cases/year (R-2 = 0.83) and was associated with adult reconstruction (P < 0.001) and oncology (P < 0.001) fellowship training. Any complication of THA for FNF (32%, P = 0.261), readmission (9% overall, P = 0.321), and reoperation (5%, P = 0.200) was not significantly associated with fellowship training.Conclusions: Between 2007 and 2020, femoral neck fracture surgery was performed by fewer American Board of Orthopaedic Surgery Part II examination candidates and there was greater use of THA. Over this period, the prevalence of fellowship training increased. Complications were not associated with fellowship training. Complications were associated with FNF case volume.Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.