Hip fracture management and NICE guidelines

Abstract

Hip fractures are an economic burden on the NHS. In view of the variety of practice nationwide, the National Institute for Health and Clinical Excellence released hip fracture guidelines in June 2011. After the draft in November 2010, we audited our own practice to examine what changes need to take place to reach compliance with the guidelines. 109 patients were prospectively identified to be included in the study with no exclusions. Demographic, operative and surgical data were collected and compared with the proposed guidelines. There were 8 undisplaced intracapsular fractures, 48 displaced intracapsular fractures, 47 simple extracapsular fractures and 6 complex extracapsular fractures. 17 patients were suitable for THR, but only 3 received this procedure. 43 hemiarthroplasties were performed, of which 93% were of a proven stem design. 53 patients sustained extracapsular fractures of which 90% received the approved implant fixation. 5 patients received cannulated hip screws and 4 patients were treated conservatively. Areas for rationalisation of equipment can provide economic savings for the trust. In particular, older-fashioned Thompson and Austin-Moore hemiarthroplasties may be completely replaced with the Stryker Exeter trauma stem. The institution needs to ensure that there is an available arthroplasty surgeon and an available trauma list every day. Rationalisation of trauma equipment and consignment will provide savings for the trust.