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Adherence to a femoral neck fracture treatment guideline

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Abstract

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.

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Acknowledgments

The following principal investigators participated in this trial:

AMC, Amsterdam, the Netherlands; J. Carel Goslings (Dept. of Surgery)

Bronovo Ziekenhuis, Den Haag, the Netherlands; Maarten W.G.A. Bronkhorst (Dept. of Surgery)

Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Peter Patka (Dept. of Surgery-Traumatology)

Kennemer Gasthuis, Haarlem, the Netherlands; Martin J. Heetveld (Dept. of Surgery)

Maasstad Ziekenhuis, Rotterdam, the Netherlands; Gert R. Roukema (Dept. of Surgery)

MC Haaglanden, Den Haag, the Netherlands; Steven Rhemrev (Dept. of Surgery)

OLVG, Amsterdam, the Netherlands; Maarten P. Simons (Dept. of Surgery), Rudolf W. Poolman (Dept. of Orthopaedic Surgery)

Reinier de Graaf Gasthuis, Delft, the Netherlands; Maarten Van der Elst (Dept. of Surgery)

St. Antonius Ziekenhuis, Nieuwegein, the Netherlands; Michiel J.M. Segers (Dept. Of Surgery), Jacco A.C. Zijl (Dept. of Orthopaedic Surgery)

St. Elisabeth Ziekenhuis, Tilburg, the Netherlands; Michiel H.J. Verhofstad (Dept. of Surgery).

Tergooi Ziekenhuizen, Hilversum, the Netherlands; Jan Peter Eerenberg (Dept. of Surgery), Harm M. Van der Vis (Dept. of Orthopaedic Surgery)

UMC St Radboud, Nijmegen, the Netherlands; Jan Biert (Dept. of Surgery), Albert Van Kampen (Dept. of Orthopaedic Surgery).

UMC Utrecht, Utrecht, the Netherlands; Rogier K.J. Simmermacher (Dept. of Surgery), Paavo L. Freijzer (Dept. of Orthopaedic Surgery).

IJsselland Ziekenhuis, Rotterdam, the Netherlands; Piet A.R. De Rijcke (Dept. of Surgery)

Conflict of interest

The authors have no conflicts of interests to report. No funding was received to support this paper.

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Authors and Affiliations

  1. Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

    Stephanie M. Zielinski, Max A. Meeuwis, Peter Patka & Esther M. M. Van Lieshout

  2. Department of Surgery, Kennemer Gasthuis, P.O. Box 417, 2000 AK, Haarlem, The Netherlands

    Martin J. Heetveld

  3. Department of Surgery, St. Elisabeth Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands

    Michiel H. J. Verhofstad

  4. Department of Surgery, Maasstad Ziekenhuis, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands

    Gert R. Roukema

  5. Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

    Peter Patka

Authors
  1. Stephanie M. Zielinski
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  2. Max A. Meeuwis
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  3. Martin J. Heetveld
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  4. Michiel H. J. Verhofstad
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  5. Gert R. Roukema
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  6. Peter Patka
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  7. Esther M. M. Van Lieshout
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On behalf of the Dutch femoral neck fracture investigator group

Corresponding author

Correspondence to Esther M. M. Van Lieshout.

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Zielinski, S.M., Meeuwis, M.A., Heetveld, M.J. et al. Adherence to a femoral neck fracture treatment guideline. International Orthopaedics (SICOT) 37, 1327–1334 (2013). https://doi.org/10.1007/s00264-013-1888-3

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  • DOI: https://doi.org/10.1007/s00264-013-1888-3

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