[Trochanteric femur fractures--analysis of external quality assurance within a comprehensive survey]

Trochanteric femur fractures are a typical injury of elderly people and are of significant relevance for their quality of life.

Data on 7252 proximal femur fractures from the department of external quality assurance of the chamber of physicians of Westphalia-Lippe/Germany were analysed. Topics of interest were: patient profile, type of femur fracture, method of treatment, intra- and postoperative complications, mobility before and after fracture.

2883 of 7252 proximal femur fractures were trochanteric fractures, 89.9% of which were instable. Trochanteric fractures were either stabilised by extra-medullary implants, e.g. dynamic hip screw (DHS; 57.5%), or by intra-medullary implants, e.g. proximal femur nail (PFN; 38.3%). The following intra-operative complications were reported: bone injury, vessel injury, nerve injury, others. Intra-medullary implants caused nearly twice as many complications as DHS (1.8% vs. 1.1%; chi-square test, p < 0.01). Specialised orthopaedic trauma departments (1.7%) had fewer complications than non-specialised units (2.2%) (chi-square test, p < 0.001). Mobility after intra- and extra-medullary fixation was comparable. At the time of discharge, 58% of patients were able to walk with crutches. High-volume hospitals (151 - 175 patients) performed significantly better than low-volume hospitals (1 - 25 patients) concerning mortality and intra- and postoperative complications. However, it is not possible to infer good quality from high volume alone, because some low-volume hospitals showed excellent results.

Treatment of trochanteric femur fractures is relatively safe. Extra-medullary implants can be used for instable trochanteric fractures with good results.