Abstract
Hip fractures are common in the Western world and are an increasing problem as their incidence increasing and thus the cost to heath services is also increasing. While the treatment of intertrchanteric fractures has not changed significantly in the last two or three decades, our knowledge of the results of treatment of subcapital fracture as increased substantially as a result of several well conducted randomised studies in Europe. It is now established that displaced subcapital fractures in those over 60 years should not be treated by internal fixation because the reoperation rate is high and even if reoperation is not required the quality of the result is inferior to other options. Total hip replacement has the best outcome for displaced fractures, with a better quality of result and the lowest reoperation rate. Hemiarthroplasty has a poorer outcome than THR with poorer hip scores and a higher re-operation rate.
This raises the question “How are we doing in NZ” Data from New Zealand Health Information Service (NZHIS) suggests that approximately one third of sub-capital fractures in NZ are currently treated by internal fixation and that this proportion has not changed in recent years. This could be because the patients are young (unlikely) or that the majority of fractures are undisplaced [again unlikely]
It is proposed to investigate the treatment of subcapital fractures in New Zealand, by surveying the treatment given in three hospitals, Wellington, Palmerston North and Middlemore. Patients identified from the NZHIS data base as having been treated for a subcapital fracture in one of two time periods at one of the three hospitals will have their radiographs reviewed to determine whether or not the fracture was displaced. This data will be matched with the, the data from NZHIS to determine the treatment given. Re-admission for re-operation will also be accessed from NZHIS to determine the reoperation rate for those treated by internal fixation, hemiarthroplasty or total hip replacement.
Correspondence should be addressed to Associate Professor N. Susan Stott, Orthopaedic Department, Starship Children’s Hospital, Private Bag 92024, Auckland, New Zealand.
