The femur hip fracture of the younger patients. Contrast between guidelineand reality - Results of report card system about 1747 patients

Between January 1993 and December 1998 26,005 patients with hip fractures u nderwent treatment in departments of general surgery and traumatology in We stfalia-Lippe, Germany. Data of these patients were reported to the chamber of physicians where a report card system for external quality assurance ha s been established since 1991. 1,747 patients were between 10 and 60 years of age. Treatment according to the guideline of hip fractures of the German College of Traumatology is compared to treatment in reality. Results. Conservative treatment declined to 2% in 1998; only 43% of these c omparetively young patients were labeled as emergencies. Only 45.4% of all osteosyntheses were performed on the day of hospital admission. Almost 30% of the patients undergo hip replacement as first line therapy. Timing of op eration is related to the frequency of operations per department and specia lisation: the more operations per year the shorter the length of stay befor e operation. Early treatment is more likely in departments of traumatology than in departments of general surgery. Lethality and morbidity do not incr ease with early treatment. Conclusions. The reality of treatment of hip fractures does not meet the cr iteria of the guideline. Further efforts have to be undertaken for the bene fit of relatively young patients with hip fractures.