Quality statement 5: Subtrochanteric fracture

Quality statement

Adults with subtrochanteric fracture are treated with an intramedullary nail. [new 2016]

Rationale

Using an intramedullary device can provide mechanical protection to a potentially diseased bone. Intramedullary fixation is the treatment of choice for subtrochanteric fractures because it allows splinting of the whole of the femoral shaft. Although intramedullary nails are more expensive than extramedullary implants, they lead to fewer patients with non-union of fracture needing reoperation.

Quality measures

Structure

Evidence of local arrangements to ensure that people with subtrochanteric fracture are treated with an intramedullary nail.

Data source: Local data collection.

Process

Proportion of presentations of subtrochanteric fractures treated with an intramedullary nail.

Numerator – the number in the denominator that are treated with an intramedullary nail.

Denominator – the number of presentations of subtrochanteric fractures.

Data source: Local data collection.

Outcome

a) Number of people with non-union of fracture.

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 subtrochanteric fractures to be treated with an intramedullary nail.

Healthcare professionals (orthopaedic surgeons) perform surgery on people with subtrochanteric fractures using an intramedullary nail.

Commissioners (such as clinical commissioning groups) ensure that they commission services where people with subtrochanteric fractures are treated with an intramedullary nail.

People with a fracture outside the socket of their hip joint and a small way down the thigh bone (called a subtrochanteric fracture) have an operation to reposition the broken bone and hold it in place while it heals. This is done using a metal rod, called an intramedullary nail, which is inserted into the bone.

Source guidance

Hip fracture: management (2011) NICE guideline CG124, recommendation 1.6.8

Definitions of terms used in this quality statement

Subtrochanteric fracture

The fracture is predominantly in the 5 cm of bone immediately distal to the lesser trochanter.

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

Intramedullary nail

A metal rod, which is inserted down the middle of the femoral shaft.

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