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Variation of implant use in A1 and A2 trochanteric hip fractures: a study from the National Hip Fracture Database of England and Wales

AIMS: Patients with A1 and A2 trochanteric hip fractures represent a substantial proportion of trauma caseload, and national guidelines recommend that sliding hip screws (SHS) should be used for these injuries. Despite this, intramedullary nails (IMNs) are routinely implanted in many hospitals, at e...

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Autores principales: Baldock, Thomas E., Dixon, Jan R., Koubaesh, Carol, Johansen, Antony, Eardley, William G. P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone & Joint Surgery 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9626874/
https://www.ncbi.nlm.nih.gov/pubmed/36181320
http://dx.doi.org/10.1302/2633-1462.310.BJO-2022-0104.R1
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author Baldock, Thomas E.
Dixon, Jan R.
Koubaesh, Carol
Johansen, Antony
Eardley, William G. P.
author_facet Baldock, Thomas E.
Dixon, Jan R.
Koubaesh, Carol
Johansen, Antony
Eardley, William G. P.
author_sort Baldock, Thomas E.
collection PubMed
description AIMS: Patients with A1 and A2 trochanteric hip fractures represent a substantial proportion of trauma caseload, and national guidelines recommend that sliding hip screws (SHS) should be used for these injuries. Despite this, intramedullary nails (IMNs) are routinely implanted in many hospitals, at extra cost and with unproven patient outcome benefit. We have used data from the National Hip Fracture Database (NHFD) to examine the use of SHS and IMN for A1 and A2 hip fractures at a national level, and to define the cost implications of management decisions that run counter to national guidelines. METHODS: We used the NHFD to identify all operations for fixation of trochanteric fractures in England and Wales between 1 January 2021 and 31 December 2021. A uniform price band from each of three hip fracture implant manufacturers was used to set cost implications alongside variation in implant use. RESULTS: We identified 18,156 A1 and A2 trochanteric hip fractures in 162 centres. Of these, 13,483 (74.3%) underwent SHS fixation, 2,352 (13.0%) were managed with short IMN, and 2,321 (12.8%) were managed with long IMN. Total cost of IMN added up to £1.89 million in 2021, and the clinical justification for this is unclear since rates of IMN use varied from 0% to 97% in different centres. CONCLUSION: Most trochanteric hip fractures are managed with SHS, in keeping with national guidelines. There is considerable variance between hospitals for implant choice, despite the lack of evidence for clinical benefit and cost-effectiveness of more expensive nailing systems. This suggests either a lack of awareness of national guidelines or a choice not to follow them. We encourage provider units to reassess their practice if outwith the national norm. Funding bodies should examine implant use closely in this population to prevent resource waste at a time of considerable health austerity. Cite this article: Bone Jt Open 2022;3(10):741–745.
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spelling pubmed-96268742022-11-07 Variation of implant use in A1 and A2 trochanteric hip fractures: a study from the National Hip Fracture Database of England and Wales Baldock, Thomas E. Dixon, Jan R. Koubaesh, Carol Johansen, Antony Eardley, William G. P. Bone Jt Open Trauma AIMS: Patients with A1 and A2 trochanteric hip fractures represent a substantial proportion of trauma caseload, and national guidelines recommend that sliding hip screws (SHS) should be used for these injuries. Despite this, intramedullary nails (IMNs) are routinely implanted in many hospitals, at extra cost and with unproven patient outcome benefit. We have used data from the National Hip Fracture Database (NHFD) to examine the use of SHS and IMN for A1 and A2 hip fractures at a national level, and to define the cost implications of management decisions that run counter to national guidelines. METHODS: We used the NHFD to identify all operations for fixation of trochanteric fractures in England and Wales between 1 January 2021 and 31 December 2021. A uniform price band from each of three hip fracture implant manufacturers was used to set cost implications alongside variation in implant use. RESULTS: We identified 18,156 A1 and A2 trochanteric hip fractures in 162 centres. Of these, 13,483 (74.3%) underwent SHS fixation, 2,352 (13.0%) were managed with short IMN, and 2,321 (12.8%) were managed with long IMN. Total cost of IMN added up to £1.89 million in 2021, and the clinical justification for this is unclear since rates of IMN use varied from 0% to 97% in different centres. CONCLUSION: Most trochanteric hip fractures are managed with SHS, in keeping with national guidelines. There is considerable variance between hospitals for implant choice, despite the lack of evidence for clinical benefit and cost-effectiveness of more expensive nailing systems. This suggests either a lack of awareness of national guidelines or a choice not to follow them. We encourage provider units to reassess their practice if outwith the national norm. Funding bodies should examine implant use closely in this population to prevent resource waste at a time of considerable health austerity. Cite this article: Bone Jt Open 2022;3(10):741–745. The British Editorial Society of Bone & Joint Surgery 2022-10-01 /pmc/articles/PMC9626874/ /pubmed/36181320 http://dx.doi.org/10.1302/2633-1462.310.BJO-2022-0104.R1 Text en © 2022 Author(s) et al. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Trauma
Baldock, Thomas E.
Dixon, Jan R.
Koubaesh, Carol
Johansen, Antony
Eardley, William G. P.
Variation of implant use in A1 and A2 trochanteric hip fractures: a study from the National Hip Fracture Database of England and Wales
title Variation of implant use in A1 and A2 trochanteric hip fractures: a study from the National Hip Fracture Database of England and Wales
title_full Variation of implant use in A1 and A2 trochanteric hip fractures: a study from the National Hip Fracture Database of England and Wales
title_fullStr Variation of implant use in A1 and A2 trochanteric hip fractures: a study from the National Hip Fracture Database of England and Wales
title_full_unstemmed Variation of implant use in A1 and A2 trochanteric hip fractures: a study from the National Hip Fracture Database of England and Wales
title_short Variation of implant use in A1 and A2 trochanteric hip fractures: a study from the National Hip Fracture Database of England and Wales
title_sort variation of implant use in a1 and a2 trochanteric hip fractures: a study from the national hip fracture database of england and wales
topic Trauma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9626874/
https://www.ncbi.nlm.nih.gov/pubmed/36181320
http://dx.doi.org/10.1302/2633-1462.310.BJO-2022-0104.R1
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