PURPOSE: In 2007 the Dutch Surgical Society published a clinical practice guideline for the treatment of hip fracture patients, based on the best available international evidence at that time. We investigated to what extent treatment of femoral neck fracture patients in the Netherlands corresponded with these guidelines, and determined differences in patient characteristics between the treatment groups. METHODS: All femoral neck fracture patients treated in 14 hospitals between February 2008 and August 2009 were included. Patient characteristics, X-rays, and treatment data were collected retrospectively. RESULTS: From a total of 1,250 patients 59% had been treated with arthroplasty, 39% with internal fixation, and 2% with a non-operative treatment. While 74% of the treatment choices complied with the guideline, 12% did not. In 14% adherence could not be determined from the available data. Arthroplasty was preferred over internal fixation in elderly patients with severe comorbidity, pre-fracture osteoporosis and a displaced fracture, who were ambulatory with aids pre-fracture (odds ratio, OR 2.2-58.1). Sliding hip screws were preferred over cancellous screws in displaced fractures (OR 1.9). CONCLUSIONS: Overall guideline adherence was good. Most deviations concerned treatment of elderly patients with a displaced fracture and implant use in internal fixation. Additional data on these issues, preferably at a higher scientific level of evidence, is needed in order to improve the guideline and to reinforce a more uniform treatment of these patients.
PURPOSE: In 2007 the Dutch Surgical Society published a clinical practice guideline for the treatment of hip fracturepatients, based on the best available international evidence at that time. We investigated to what extent treatment of femoral neck fracturepatients in the Netherlands corresponded with these guidelines, and determined differences in patient characteristics between the treatment groups. METHODS: All femoral neck fracturepatients treated in 14 hospitals between February 2008 and August 2009 were included. Patient characteristics, X-rays, and treatment data were collected retrospectively. RESULTS: From a total of 1,250 patients 59% had been treated with arthroplasty, 39% with internal fixation, and 2% with a non-operative treatment. While 74% of the treatment choices complied with the guideline, 12% did not. In 14% adherence could not be determined from the available data. Arthroplasty was preferred over internal fixation in elderly patients with severe comorbidity, pre-fracture osteoporosis and a displaced fracture, who were ambulatory with aids pre-fracture (odds ratio, OR 2.2-58.1). Sliding hip screws were preferred over cancellous screws in displaced fractures (OR 1.9). CONCLUSIONS: Overall guideline adherence was good. Most deviations concerned treatment of elderly patients with a displaced fracture and implant use in internal fixation. Additional data on these issues, preferably at a higher scientific level of evidence, is needed in order to improve the guideline and to reinforce a more uniform treatment of these patients.
Authors: Mohit Bhandari; P J Devereaux; Paul Tornetta; Marc F Swiontkowski; Daniel J Berry; George Haidukewych; Emil H Schemitsch; Beate P Hanson; Kenneth Koval; Douglas Dirschl; Pamela Leece; Marius Keel; Brad Petrisor; Martin Heetveld; Gordon H Guyatt Journal: J Bone Joint Surg Am Date: 2005-09 Impact factor: 5.284
Authors: Paul T P W Burgers; Arnoud R Van Geene; Michel P J Van den Bekerom; Esther M M Van Lieshout; Bastiaan Blom; Ilyas S Aleem; M Bhandari; Rudolf W Poolman Journal: Int Orthop Date: 2012-05-24 Impact factor: 3.075
Authors: Paul T P W Burgers; Stephanie M Zielinski; Adinda K E Mailuhu; Martin J Heetveld; Michiel H J Verhofstad; Gert R Roukema; Peter Patka; Rudolf W Poolman; Esther M M Van Lieshout Journal: Int Orthop Date: 2014-08-03 Impact factor: 3.075
Authors: Christopher H Rashidifard; Nicholas Romeo; Mark Richardson; Paul Muccino; Thomas DiPasquale; Chelsea M Bush Journal: Geriatr Orthop Surg Rehabil Date: 2019-03-11