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. 2023 Apr 25;6(2):e274.
doi: 10.1097/OI9.0000000000000274. eCollection 2023 Jun.

Trends in implementation of evidence-based hip fracture management in a major Canadian city

Martina Vergouwen  1 , Michael G James  2 , Daniel Z You  1 , Neil J White  1
Affiliations

Trends in implementation of evidence-based hip fracture management in a major Canadian city

Martina Vergouwen et al. OTA Int. .

Abstract

Aims: The importance of hip fracture care has resulted in an abundance of hip fracture management literature. The degree this evidence is incorporated into clinical practice is unknown. We examined 5 trends in hip fracture management: arthroplasty versus fixation, total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented femoral stem fixation, short versus long cephalomedullary nail (CMN) fixation, and time from admission to surgery. Our primary aim was to understand and assess hip fracture management trends in relation to pertinent literature.

Methods: Data were collected from acute hip fractures in patients aged 50 years or older who presented from 2008 to 2018. ICD-10 diagnostic codes were assigned using preoperative radiographs. Surgical management was confirmed using intraoperative and postoperative radiographs and split into 6 categories: (1) short CMN, (2) long CMN, (3) cannulated screws, (4) dynamic hip screw, (5) HA, and (6) THA. Appropriate statistical tests were used to analyze trends.

Results: In 4 assessed trends, hip fracture management aligned with high-level evidence. This was the case for a trend toward arthroplasty for displaced femoral neck fractures, increased use of THA relative to HA, increased use of short relative to long CMNs, and consistent decrease in surgical wait times. Despite the literature highlighting the disadvantages of uncemented femoral stems, our data demonstrated increased use of uncemented femoral stems.

Conclusion: Evidence to guide orthopaedic practice is constantly emerging but may not be effectively used by clinicians. Our findings demonstrate the successes and failures of integrating evidence into hip fracture management and highlight that orthopaedic surgeons have an ongoing responsibility to strive for evidence-based practice.

Keywords: evidence-based practice; hip fracture management; orthopaedic trauma; surgical; trends.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Number of acute hip fracture surgeries by year.
Figure 2.
Figure 2.
Percent breakdown of hemiarthroplasty versus total arthroplasty per year.
Figure 3.
Figure 3.
Percent breakdown of cemented versus uncemented hemiarthroplasty per year.
Figure 4.
Figure 4.
Percent breakdown of short versus long cephalomedullary nails per year.
See this image and copyright information in PMC

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