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Published on: September 14, 2017
Defining a Hip Fracture: Surveying Orthopaedic Surgeons to Better Characterize the Injury
Tara K Gloystein1, Laura J Gerhardinger, Joey P Johnson
1From the Department of Orthopaedic Surgery, Western Michigan School of Medicine, Kalamazoo, MI (Gloystein), the Department of Surgery, University of Michigan, Ann Arbor, MI (Gerhardinger), the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI (Gerhardinger and Oliphant), the Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL (Johnson), the Department of Orthopaedic Surgery, Dartmouth Health, Lebanon, NH (Miller and Wolinsky), and the Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI (Oliphant).
Healthcare agency definitions of hip fractures do not align with orthopaedic surgeons' views. A modified hip fracture definition (MHFD) is needed for accurate diagnosis and improved quality improvement programs.
Area of Science:
- Orthopaedic Surgery
- Health Services Research
Background:
- Current healthcare agency definitions for hip fractures are broad and may not reflect clinical practice.
- It remains unclear if these broad definitions align with the understanding of physicians treating hip fractures.
Purpose of the Study:
- To investigate orthopaedic surgeons' definitions of hip fractures.
- To compare surgeons' definitions with existing healthcare agency definitions.
Main Methods:
- An internet-based survey was conducted among orthopaedic surgeons.
- Surgeons were asked to define hip fractures and identify included fracture types for a modified hip fracture definition (MHFD).
- Treatment practices, comorbidities, and costs were compared across patient groups.
Main Results:
- Eighty-five orthopaedic surgeons participated.
- Nearly all surgeons included femoral neck (96.5%) and intertrochanteric (95.3%) fractures in the MHFD.
- Half included subtrochanteric fractures (49.4%), and a quarter included femoral head or stable trochanteric fractures (27.1%).
- Patients within the MHFD group had more procedures, higher inpatient costs, and higher discharge care levels.
Conclusions:
- Current hip fracture definitions used by healthcare agencies lack alignment with practicing orthopaedic surgeons.
- Enhanced hip fracture definitions are necessary for effective quality improvement initiatives.
- A more precise definition is crucial due to the heterogeneity of hip fracture injuries.
