Changing trends in the management of intertrochanteric hip fractures - a single centre experience

Piers R. J. Page, Roxana Lord, Ahsin Jawad, Edward Dawe, Philip Stott, Benedict Rogers, Richie Gill

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With an annual incidence greater than 65,000 in the United
Kingdom, hip fractures are a common but debilitating injury predominantly
affecting those over 65. Treatment is based on the anatomical location of
the fracture relative to the capsule of the hip joint - fractures
occurring within it are treated by arthroplasty, while extracapsular
fractures are an indication for fixation. Intertrochanteric fractures are
further grouped as stable (AO/OTA 31A1/A2) or unstable (31A3) which in
turn governs in the current UK guidelines whether this fixation is
achieved with a dynamic hip screw or intramedullary device. Anecdotally,
some units are tending towards intramedullary devices for 31A2 fractures
as well, a practice which from the evidence does not appear to confer
benefit and carries an excess cost. We reviewed our data submitted to the
National Hip Fracture Database over the last five years and identified
all intertrochanteric fractures, from which cohort we identified all
patients with 31A2 fractures by review of radiographs. The cohort
comprised 370 patients. We then recorded age, gender, ASA grade,
abbreviated mental test score, residence from where admitted, length of
stay, destination on discharge and whether any further operations were
required. There was no significant difference in the demographics of the
groups, year-on-year, except gender mix. There was a significant, twentyfold
rise in the use of intramedullary devices between 2011 and 2015.
Length of stay, length of overall episode of care, revision rates,
mortality and destination on discharge were unchanged. This use is not
supported by NICE guidelines and this study offers no evidence to
contradict this position. We advocate all centres examine their practice
to avoid a costly intervention without clinical benefit.
Original languageEnglish
Pages (from-to)1525-1529
Issue number7
Early online date7 May 2016
Publication statusPublished - Jul 2016


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