Elsevier

Injury

Volume 33, Issue 5, June 2002, Pages 383-386
Injury

A survey of the treatment of displaced intracapsular femoral neck fractures in the UK

https://doi.org/10.1016/S0020-1383(02)00002-5Get rights and content

Abstract

A survey was undertaken to investigate the treatment of displaced intracapsular femoral neck fractures across the UK. The usual practice at 223 hospitals was recorded for two groups of patients, active and frail. Management of stereotyped fractures, in similar patients, varied between hospitals. There was also variation between specialists within some hospitals: two or more of the alternative methods of treatment were in routine use for active patients at 22% of hospitals and for frail patients at 27%. Overall, for active patients, bipolar hemiarthroplasty was undertaken at 41% of hospitals, internal fixation at 37%, unipolar hemiarthroplasty at 32% and total hip replacement at 16%. Cemented prostheses were used in 74% of arthroplasties for active patients. For frail patients, hemiarthroplasty with an Austin Moore or Thompson prostheses was undertaken at 94% of hospitals; bipolar prostheses were used at 8%; internal fixation was undertaken at 1%. Cement was used in 46% of hemiarthroplasties. These findings indicate a lack of consensus in aspects of the treatment of displaced intracapsular femoral neck fractures and are likely to reflect difficulties in determining “best practice.”

Introduction

A patient with a proximal femoral “hip” fracture is admitted to each district general hospital in the UK, on average, nearly every day [1]. Whilst the treatment of extracapsular fractures may be evidence-based [2], surveys in the past have indicated a lack of agreement on the treatment of intracapsular fractures [3]. Controversy may apply particularly to the treatment of displaced intracapsular fractures. Considerations in such cases include whether, with the risk of non-union and avascular necrosis, the femoral head should be replaced and if so, details of the most appropriate prosthetic replacement [4]. We conducted a survey of current practice across hospitals in the UK to investigate the degree of consensus in the treatment of patients with displaced intracapsular femoral neck fractures. The degree of consensus was assessed by comparing how widely each of the surgical options were used, as indicated by the proportion of hospitals at which each operation was in routine practice.

Section snippets

Methods

The survey was conducted between March and July 2000. The middle grade orthopaedic surgeon on-call at every hospital in the UK taking acute orthopaedic admissions, identified by contacting all of the hospitals listed in the Medical Directory [5], was interviewed by telephone. Respondents were asked to report the usual treatment at their hospital for displaced intracapsular hip fractures, considering solely operative management of the fracture and assuming the absence of concomitant medical

Results

Information was obtained for each of the 223 hospitals identified, taking acute orthopaedic admissions. In the majority of hospitals a single method of treatment was used (78% for active patients, 73% for frail, Fig. 1). Two or more procedures were in routine practice for active patients at 22% of hospitals and for frail patients at 27%. Non-operative treatment for displaced femoral neck fractures was not routinely practised at any hospital.

The proportions of the 223 hospitals at which the

Discussion

Whilst this survey demonstrated some elements of agreement, there was also a lack of consensus in several important areas relating to the treatment of displaced intracapsular femoral neck fractures.

Agreement was apparent in the widespread treatment of fractures in frail patients by unipolar hemiarthroplasty and the desire not to use a bipolar prostheses, internal fixation and total hip replacement in this group. There is some support for these policies. Treating fractures in frail patients by

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