Trocantheric Femoral Fractures - a retrospective cohort study comparing reoperation rates before and after implementation of new treatment protocol

Abstract: Introduction: Hip fractures are very common in Sweden. Keeping reoperation rates as low as possible is critical. One factor correlated to mechanical complications and thereby reoperation rates is the tip-apex distance. In April of 2017 the Orthopedic clinic at Karlstad’s Central Hospital in Sweden implemented new routines for the choice of treatment method of pertrocantheric and subtrocantheric femoral fractures. Aim: The primary aim of this study was to compare reoperation rates of pertrocantheric and subtrocantheric femoral fractures before and after implementation of new routines. Secondly, we wanted to study the association between the tip-apex distance and reoperation rates for pertrocantheric femoral fractures treated at Karlstad’s Central Hospital. Method: This was an internal quality control designed as a retrospective cohort study. Data on patients treated for pertrocantheric or subtrocantheric femoral fractures were retrieved from the Swedish Fracture Registry. Tip-apex distances were measured on patients’ radiographic images. P-values for comparison of the two study periods were created using the chi2 test. Association between the tip-apex distance and reoperation rate was presented as odds ratio. Result: The reoperation rates were the same for both time periods. The reoperation rates of unstable fractures were lower for the study period after implementation of new routines. Neither of these results were statistically significant. There was also no statistically significant association between the tip-apex distance and reoperation rates. Conclusion: No statistically significant decrease in reoperation rates was seen after implementation of new routines. There was no association between the tip-apex distance and reoperation rates.