AN ALGORITHM FOR HIP FRACTURE SURGERY REDUCED THE ONE-YEAR REOPERATION RATE FROM 18% TO 12%

Introduction We implemented an exhaustive operative and supervision algorithm for surgical treatment of hip fractures primarily based on own previously published literature. The purpose was to improve supervision and reduce the rate of reoperations. Materials and methods 2000 consecutive unselected patients above 50 years admitted with a hip fracture were included, 1000 of these prospectively after implementation of the algorithm. Demographic parameters, hospital treatment and reoperations within the first postoperative year were assessed from patient records. The algorithm dictated the surgical treatment based on three objective patient parameters: age, new mobility score and fracture classification on pre-operative anterior-posterior and axial radiographs. Intra capsular fractures were treated with two parallel implants, a sliding hip screw, an arthroplasty or resection of the femoral head. Extra capsular fractures were treated with a sliding hip screw or an intramedullary nail. Supervision of junior registrars was mandatory for the prosthesis and intramedullary nail procedures. Results 931/1000 operative procedures were operated according to the algorithm, compared to only 726/1000 prior to its introduction (p After implementing the algorithm, junior registrars still performed half of the operations, but unsupervised procedures declined from 192/1000 to 105/1000 (p=0.039). The rate of reoperations declined from 18% to 12% (p Conclusion An exhaustive algorithm for hip fracture treatment can be implemented. In our case, the algorithm both raised the rate of supervision and reduced the rate of reoperations, the latter saving many hospital bed-days.