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International Orthopaedics
Published in: International Orthopaedics 7/2013

01-07-2013 | Original Paper

Adherence to a femoral neck fracture treatment guideline

Authors: Stephanie M. Zielinski, Max A. Meeuwis, Martin J. Heetveld, Michiel H. J. Verhofstad, Gert R. Roukema, Peter Patka, Esther M. M. Van Lieshout, On behalf of the Dutch femoral neck fracture investigator group

Published in: International Orthopaedics | Issue 7/2013

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Abstract

Purpose

In 2007 the Dutch Surgical Society published a clinical practice guideline for the treatment of hip fracture patients, based on the best available international evidence at that time. We investigated to what extent treatment of femoral neck fracture patients in the Netherlands corresponded with these guidelines, and determined differences in patient characteristics between the treatment groups.

Methods

All femoral neck fracture patients treated in 14 hospitals between February 2008 and August 2009 were included. Patient characteristics, X-rays, and treatment data were collected retrospectively.

Results

From a total of 1,250 patients 59 % had been treated with arthroplasty, 39 % with internal fixation, and 2 % with a non-operative treatment. While 74 % of the treatment choices complied with the guideline, 12 % did not. In 14 % adherence could not be determined from the available data. Arthroplasty was preferred over internal fixation in elderly patients with severe comorbidity, pre-fracture osteoporosis and a displaced fracture, who were ambulatory with aids pre-fracture (odds ratio, OR 2.2–58.1). Sliding hip screws were preferred over cancellous screws in displaced fractures (OR 1.9).

Conclusions

Overall guideline adherence was good. Most deviations concerned treatment of elderly patients with a displaced fracture and implant use in internal fixation. Additional data on these issues, preferably at a higher scientific level of evidence, is needed in order to improve the guideline and to reinforce a more uniform treatment of these patients.
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Metadata
Title
Adherence to a femoral neck fracture treatment guideline
Authors
Stephanie M. Zielinski
Max A. Meeuwis
Martin J. Heetveld
Michiel H. J. Verhofstad
Gert R. Roukema
Peter Patka
Esther M. M. Van Lieshout
On behalf of the Dutch femoral neck fracture investigator group
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
International Orthopaedics / Issue 7/2013
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-1888-3

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