Quality statement 5: Subtrochanteric fracture
Adults with subtrochanteric fracture are treated with an intramedullary nail. [new 2016]
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.
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Evidence of local arrangements to ensure that people with subtrochanteric fracture are treated with an intramedullary nail.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, from service specifications and clinical protocols.
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: The National Hip Fracture Database records the use of an intramedullary nail for subtrochanteric fractures.
Number of people with non-union of subtrochanteric fracture.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
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 integrated care systems) 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.
Hip fracture: management. NICE guideline CG124 (2011, updated 2023), recommendation 1.6.10
The fracture is predominantly in the 5 cm of bone immediately distal to the lesser trochanter. [NICE's full guideline on hip fracture]
A metal rod, which is inserted down the middle of the femoral shaft. [NICE's full guideline on hip fracture]