Bilance of the tracerdiagnose "fracture of the femurneck". A report about 5 years of quality assurance

A report card system for fractures of the femur neck has been established a t the department of external quality assurance of the chamber of physicians of Westphalia-Lippe since 1993. Since then several indicators of good qual ity have significantly changed: conservative treatment decreased from 6.8 % 1993 to 4.2 % in 1997, lethality decreased from 6.9 % to 5.4 %, average le ngth of stay before operation decreased from 2.6 to 2.1 days, the frequency of operations on weekends increased, complications in wound healing increa sed from 4.9 to 6.0 %, cardiopulmonary complications decreased from 11.2 % to 7.8 %. Between 1993 to 1997 54.3 % could be dismissed to their homes; th e percentage of patients being sent to rehabilitation facilities after acut e care rose from 8.3 % in 1993 to 20.1 % in 1997. Operative treatment was p erformed in more than 90 % of all fractures in all counties of Westphalia-L ippe. However, there was a wide and significant geographical variation in t he choice between osteosyntheses and hip replacement: the percentage of hip replacement differed between 57 % and 82 % among different counties.