Quality statement 4: Trochanteric fracture

Quality statement

Adults with trochanteric fractures above and including the lesser trochanter receive extramedullary implants. [2012, updated 2016]

Rationale

Extramedullary implants, such as sliding hip screws, have similar clinical outcomes to intramedullary devices. However, some studies have shown that intramedullary implants have a higher reoperation rate because of periprosthetic fracture. In addition, extramedullary implants are less expensive than intramedullary implants. Therefore, extramedullary implants are recommended in preference to intramedullary nails for the treatment of trochanteric fractures.

Quality measures

Structure

Evidence of local arrangements to ensure that people with trochanteric fractures above and including the lesser trochanter receive extramedullary implants.

Data source: Local data collection.

Process

Proportion of presentations of trochanteric fractures above and including the lesser trochanter in which the person receives extramedullary implants.

Numerator – the number in the denominator in which the person receives extramedullary implants.

Denominator – the number of presentations of trochanteric fractures above and including the lesser trochanter.

Data source: Local data collection. The National Hip Fracture Database records procedure type for trochanteric fracture.

Outcome

Reoperation rates for people with trochanteric fractures.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (hospitals) ensure that systems are in place for people with trochanteric fractures above and including the lesser trochanter to receive extramedullary implants in preference to intramedullary nails.

Healthcare professionals (orthopaedic surgeons) ensure that people with trochanteric fractures above and including the lesser trochanter receive extramedullary implants in preference to intramedullary nails.

Commissioners (such as clinical commissioning groups) ensure that they commission services where people with trochanteric fractures above and including the lesser trochanter receive extramedullary implants in preference to intramedullary nails.

People with a fracture outside the socket of their hip joint and near the top of the thigh bone (called a trochanteric fracture) have an operation to reposition the broken bone and hold it in place while it heals. This is done using one or more special screws inserted into the bone and attached to a metal plate (called an extramedullary implant).

Source guidance

Hip fracture: management (2011) NICE guideline CG124, recommendation 1.6.7 (key priorities for implementation)

Definitions of terms used in this quality statement

Trochanteric fractures

Fractures that occur outside or distal to the hip joint capsule, which can be two-part fractures (stable) or multi-fragmentary (unstable).

[NICE's guideline on hip fracture, full guideline]

Extramedullary implants

A screw that is attached to a plate on the outside of the femoral head and neck.

[NICE's guideline on hip fracture, full guideline]