Almost all patients with a hip fracture will benefit from surgical treatment. The upper end of the thigh bone has lumps or ‘trochanters’ where muscles attach to it. Fractures are divided into three general types depending on whether the bone breaks through this area (‘intertrochanteric’), below it (‘subtrochanteric’), or above it, within the hip joint itself (‘intracapsular’). NICE recommends different types of operation depending on the exact site of fracture. A surgeon will normally discuss the pros and cons of various types of operation with the patient and agree a plan together.
• Percentage of arthroplasties (hemiarthroplasty and THR) that are cemented: An intracapsular fracture can sometimes be fixed with screws, but if it is displaced it can damage the blood flow to the bone within the hip joint and this may require a partial or total replacement of the joint. NICE recommends that bone cement is used to support the metal replacement within the thigh bone.
• Percentage of eligible cases (defined by NICE CG124) who have a total hip replacement: NICE recommends that patients who have a displaced intracapsular fracture, are fit for surgery and anaesthetic, have normal cognitive function and are able to walk outside using no more than a stick should be considered for a total (rather than a partial) hip replacement.
• Percentage of intertrochanteric fractures treated with a sliding hip screw: An intertrochanteric fracture is commonly treated with an operation which fixes the fracture with a metal plate and sliding hip screw.
• Percentage of subtrochanteric fractures treated with an intramedullary nail: A subtrochanteric fracture is a fracture below the trochanters between the hip and the shaft of the femur. These fractures are best treated with an operation which fixes the fracture with an intramedullary nail.
• Percentage of cases treated non-operatively: A few patients will not be eligible for surgery – for example patients with cancer who are expected to die within a day or so. But evidence suggests that nearly all patients should have surgery, even if just to ensure that they can be nursed with comfort and dignity in the last days and weeks of life. A surgeon will normally discuss the pros and cons of various types of operation with the patient and agree a plan together.
This chart has is based upon the criteria of the 2011 NICE Guideline. Its specifications have remained unchanged so the chart can be used to monitor the impact of subsequent research and NICE updates.
For more information on hip fracture, please see the NHFD patient report ‘My Hip Fracture Care: 12 questions to ask’. This is a guide to hip fracture injury and treatment for patients, their families and carers and is available on the NHFD homepage: www.nhfd.co.uk
Technical Summary
This run-chart shows:
1. The average % number of patients having an intramedullary nail (IM Nail) for a subtrochanteric hip fracture
2. The average % number of patients having a sliding hip screw (SHS) for an intertrochanteric hip fracture
3. The average % number of patients having cemented arthroplasty (of all arthroplasties performed)
4. The average % number of patients having a total hip replacement (THR) when indicated
5. The average % number of patients not having surgery ('No-Operations')
Data selection
The chart includes all patient records from April 2011 to the end of the month before the previous month, but excluding:
1. Patients < 60 years old
2. Duplicate records, where detected
3. Data errors (Missing data/erroneous data or record conflicts, where detected)
Time axis
The charts use 'Admission Date' as the main monthly time-base. Patients are counted based on the year and month they were admitted to Hospital (acute stay).
Update frequency
Chart data is updated every hour, but only records older than the current or previous month will be included.
Definitions
Rate of non-operative management %
N: cases where Operation Performed field has value ‘No operation performed’
D: total cases
CG124 1.6.5 Arthroplasty cementation %
N: cases where Operation Performed field has value ‘Arthroplasty - Unipolar hemi (cemented)’ or ‘Arthroplasty - Bipolar hemi (cemented)’ or ‘Arthroplasty - THR (cemented)’ or ‘THR Hybrid’
D: total number of arthroplasties (Operation Performed field), including ‘THR Hybrid’
CG124 1.6.3 THR when indicated %
N: cases where Type of fracture field has value ‘Intracapsular- displaced’ and ASA grade field has value ‘1’, ‘2’ or ‘3’ and Pre-fracture mobility field* has the value ‘Freely mobile without aids’ or ‘Mobile outdoors with one aid’ and AMTS Pre op field has value ‘8’ or more and Operation Performed field has value ‘Arthroplasty - THR (uncemented - uncoated)’, ‘Arthroplasty - THR (uncemented - HA coated)’, ‘Arthroplasty - THR (cemented)’ or ‘THR Hybrid’
D: cases where Type of fracture field has value ‘Intracapsular- displaced’ and ASA grade field has value ‘1’, ‘2’ or ‘3’ and Pre-fracture mobility field* has the value ‘Freely mobile without aids’ or ‘Mobile outdoors with one aid’ and AMTS Pre op field has value ‘8’ or more. (Note: Mobility is a combination of current dataset definition and previous V8 field 'Pre-fracture mobility' and equivalent V7 definition based on 'walking ability' data).
CG124 1.6.7 Intertrochanteric fractures having a SHS %
N: cases where Type of fracture field has value ‘Intertrochanteric’ and Operation Performed field has value ‘Internal fixation - Sliding Hip Screws’
D: cases where Type of fracture field has value ‘Intertrochanteric’
CG124 1.6.8 Subtrochanteric fractures having an IM nail %
N: cases where Type of fracture field has value ‘Subtrochanteric’ and Operation Performed field has value ‘Internal fixation - IM nail (long)’ or ‘Internal fixation - IM nail (short)’
D: cases where Type of fracture field has value ‘Subtrochanteric’
Average percentage data calculations
An annualised rolling average calculation is used: Sum(X) / Sum(N) over the preceding 12 month period, for every month and recorded in the last month of the period. Since a value for the first 12 month period is displayed on the 12th month, the first 11 months do not display a value.