A Quality Improvement Project to Improve Periprosthetic Fracture Management at District General Hospitals.

Abstract

Introduction The incidence of periprosthetic femoral fractures (PPF) is expected to rise by 4.6% every decade over the next 30 years. The risk of mortality for patients who sustained a PPF was found to be similar to the mortality rate after a native hip fracture, and so The National Institute for Health and Care Excellence (NICE) guidelines advocate the timely management and mobilisation for patients with PPFs. Patient outcomes following these complex surgeries can be highly variable owing to the variability in regional practice and service delivery. This study aimed to review the management trend and outcomes of periprosthetic fractures (PPFs) involving hip and knee prostheses at a busy district general hospital in order to improve the overall efficacy in managing these complex fractures. Methods This retrospective study included 67 patients who presented to a single district general hospital during a two-year period. Data was collected on demographic profile, further onward referral to a tertiary centre, management (operative versus conservative), timing of surgery, complications, length of stay, implant survivorship, 30-day, one-year, and two-year mortality rate. Results Out of the total of 67 PPFs, 51 (76%) were managed operatively, and 16 (24%) were managed conservatively. Of the operatively managed PPFs, 49 (96%) were managed locally at the district general hospital, and two (4%) were managed at the tertiary centre. Eighteen patients (37%) underwent both revision and fixation, whilst 31 (63%) underwent fixation alone. The mortality rates at 30 days, one year, and two years were 10.4%, 20.9%, and 25.4%, respectively. For PPF patients managed operatively, the mean time taken from presentation to operation was 89.2 hours. The overall mean length of hospital stay for all patients was 23.6 days. Eight patients suffered complications. The implant survivorship at two years was 98%. Conclusion This study adds objective support for the successful operative management of PPFs at district general hospitals. However, improvement is required in service delivery and the efficacy of management. This could be achieved by a national database for PPFs, improved resource allocation, and prompt logistical support.