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Inter-departmental variation in surgical treatment of proximal femoral fractures: A nationwide observational cohort study
Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden.ORCID-id: 0000-0002-9699-7743
Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Centre of Registers, Västra Göraland, Gothenburg, Sweden.
Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden.
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2023 (Engelska)Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 18, nr 2, artikel-id e0281592Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND AND PURPOSE: Hip fractures should be treated based on the best available evidence and cost-effectively to optimize the outcome for this large group of frail patients. This study examined nationwide variation in surgical methods used for hip fractures.

METHODS: In this cohort study 46,243 patients ≥65 years with a trochanteric hip fracture (THF) or a femoral neck fracture (FNF) registered in the Swedish Fracture Register (SFR) between 1 January 2016 and 31 December 2020 were included. Fractures were classified according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification system. The choice of surgical methods was assessed for each fracture type to compare national variation.

RESULTS: 21,312 THFs and 24,072 FNFs (67% women) with a mean age of 83 years (SD 8) were surgically treated. In the treatment of two-fragment THFs (AO/OTA A1) departments ranged from using 90% short intramedullary nails to 98% sliding hip screws. Treating displaced FNFs (AO/OTA B3), the proportion of hemiarthroplasty ranged from 9 to 90%, and internal fixation between 0.6 to 21%, depending on the department.

INTERPRETATION: A mature national fracture register permits the monitoring of treatment provided and thus serves as an important aid in assessing compliance with guidelines. The large inter-departmental variation in the surgical management of hip fractures in Sweden appears unwarranted based on the current evidence, indicating a need for updated national guidelines. Further research will have to clarify the impact of this variation on mortality and re-operation rates.

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Public Library of Science , 2023. Vol. 18, nr 2, artikel-id e0281592
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URN: urn:nbn:se:umu:diva-204789DOI: 10.1371/journal.pone.0281592ISI: 000929724500090PubMedID: 36757969Scopus ID: 2-s2.0-85147834375OAI: oai:DiVA.org:umu-204789DiVA, id: diva2:1736356
Tillgänglig från: 2023-02-13 Skapad: 2023-02-13 Senast uppdaterad: 2023-03-06Bibliografiskt granskad

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