Related Experiment Video
Updated: Sep 16, 2025
A Method to Estimate Cadaveric Femur Cortical Strains During Fracture Testing Using Digital Image Correlation
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).
Insights
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.
Introduction:
Entities such as The Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality include a large swath of heterogenous hip fracture diagnoses together when defining this injury. However, it is unclear if these broad definitions are in line with those of physicians who treat these injuries. We queried orthopaedic surgeons to understand how they would define a hip fracture and how their definition compares with the ones currently in use by healthcare agencies.
Methods:
We conducted an internet-based survey of orthopaedic surgeons to ascertain which standard hip fracture types they felt should be included in a modified hip fracture definition (MHFD), along with querying their current treatment practices. We also compared outcomes, medical comorbidities, and spending across patients captured in the different diagnosis groups.
Results:
Eighty-five orthopaedic surgeons completed the survey, and almost all of them felt that a femoral neck (96.5%) and intertrochanteric (95.3%) fracture should be included in the MHFD, while almost half (49.4%) would include the subtrochanteric region, and just over a quarter (27.1%) would incorporate the femoral head or a stable greater or lesser trochanter fracture. Treatment practices were largely in line with current research and patients captured by the new MHFD tended to have more procedures performed, have higher inpatient costs, and be discharged to higher levels of care compared with hip fracture patients not included in this new definition.
Conclusion:
There should be caution when using current hip fracture definitions from healthcare agencies because they do not align well with those used by practicing orthopaedic surgeons. Efforts to enhance this definition should be explored because quality improvement programs are limited by a heterogenous definition of this injury.
