Abstract
Introduction: The National Institute for Health and Care Excellence (NICE) in 2011 declared standards in the management of fracture neck of femur (NOF) patients suggesting a total hip replacement (THR) if necessary criteria were met. The Best Practice Tariff (BPT) states all NOF fracture patients should be operated on within 36 h of presentation to Accident & Emergency. We conducted this retrospective study for the years 2016–2018 to evaluate the adherence to these guidelines by Basildon and Thurrock University Hospital and compared the results with national standards. Methods: Data for the period from 2016 to 2018 was collected from the National Hip Fracture Database (NHFD) retrospectively. The data was analysed to calculate various procedures performed for fracture NOF fixations, the number of THR’s for displaced intracapsular fracture NOF, and percentage of patients operated within 36 h and evaluated reasons for the delay. Results: Over the 3 years, the number of THR eligible displaced intracapsular neck of femur fracture patients that underwent THR was above the national average. Across all 3 years, the number of patients who underwent surgery within 36 h was less than the national average. Administrative/logistic reasons for the delay were the major cause for delayed surgery in all 3 years. Conclusion: Compliance with the NICE guidelines and achievement of national standards in NOF fracture care is achievable by most district general hospitals. Awareness and implementation of NICE guidelines for THRs need to be enhanced. A sustained, continual team effort and strict vigilance are necessary to prevent delayed surgery.
Highlights
The neck of femur (NOF) fractures represents an increasing volume of patients presenting to orthopaedic departments, with over 100,000 admissions predicted in 2020 at an estimated cost of greater than £2 billion
In 2011, the National Institute of Clinical Excellence (NICE) issued guidelines for the management of hip fractures in adults, with recommendations spanning pre-operative management through to discharge and follow-up [1]. These recommendations followed the introduction of the fragility hip fracture best practice tariff (BPT) in 2010, which saw a reduction in the financial compensation paid to hospitals for the management of hip
In 2016, there were 399 NOF fractures, 33 of which were treated with a total hip replacement (THR). 151 were treated with a hemiarthroplasty
Summary
The neck of femur (NOF) fractures represents an increasing volume of patients presenting to orthopaedic departments, with over 100,000 admissions predicted in 2020 at an estimated cost of greater than £2 billion. In 2011, the National Institute of Clinical Excellence (NICE) issued guidelines for the management of hip fractures in adults, with recommendations spanning pre-operative management through to discharge and follow-up [1] These recommendations followed the introduction of the fragility hip fracture best practice tariff (BPT) in 2010, which saw a reduction in the financial compensation paid to hospitals for the management of hip NICE guidelines provide clear recommendations regarding the surgical management of fractured NOF. These state that patients with a displaced intracapsular NOF fracture should be received either a total hip replacement (THR) or hemiarthroplasty depending on their pre-fall status. THR should be offered to patients who are able to walk independently outdoors with no more than the use of a stick, who have no cognitive impairment (an Abbreviated Mental Test Score of 8 or more at admission)
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