Background. National hip fracture programmes are becoming widespread, but this practice is nascent and varied. The Scottish Hip Fracture Audit (SHFA) was an early adopter of this strategy and is credited with substantial systemic improvements in quality and outcomes. Objectives. To provide evidence and incentive to clinicians and administrators to adopt successful improvement strategies, and to facilitate data-driven change hip fracture care. Study Design and Methods. We reviewed the practice of seven national hip fracture improvement programmes in: Sweden, Denmark, Norway, Australia, New Zealand, UK, Scotland, and Ireland. We report our experience from the SHFA and describe: the results of our programme; challenges and learning points encountered, and successful strategies for implementing change. Results. There is variance in approach to data collection and reporting, for example: standalone programmes versus combined trauma and arthroplasty registries; annual trend reporting versus ‘snapshot’ or real-time information; population-level versus patient-level data, and the emphasis placed on service-level characteristics. The governance model also varies – some act as a passive data registry whereas others act as active agents of change and regulation. There is consensus on the key performance makers: prompt admission; early surgery and mobilisation, and a multidisciplinary approach. There have been significant challenges encountered by the SHFA with respect to funding, logistical, and political issues. Analysis of the effects of our programme have demonstrated its clinical efficacy, and has identified successful strategies for improvement. We describe this experience. Conclusions. The establishment of national audit programmes has resulted in significant improvements in quality, efficiency, and outcomes. This study of major national programmes provides evidence, incentive, and instruction to clinicians and administrators who seek to improve healthcare systems

Collection of new data for the Scottish hip fracture audit stopped in December 2008. The proposed standard of operating on 98% of all hip fractures within 24 hours of admission, subject to medical fitness and during safe operating hours should now be maintained. Methods. We prospectively collected data from 102 consecutive hip fracture patients documenting the patient's journey from admission to discharge from the orthopaedic ward to look at whether the standard had been maintained. Results. 50% of patients get to theatre 24hrs or earlier with 60% catheterised perioperatively.50% of patients were moved from the acute orthopaedic facility at a week with less than 20% of these getting back to their usual place of residence. 25% were still on the acute ward at two weeks and 3% died in the immediate post operative period. However, the number of co-morbidities did not seem to correlate with time to discharge. The majority of patients transferred to onward care moved to the geriatric rehabilitation ward within the hospital. Prioritisation of hip fracture patients on the trauma list needs to be continued along with improvements in the availability of rehabilitation beds. Pre-operative medical work up for patients with reversible illness and post-operative geriatric care will improve the outcomes for these frail patients

Appropriate surgical management of hip fractures has major clinical and economic consequences. Recently IMN use has increased compared to SHS constructs, despite no clear evidence demonstrating superiority of outcome. We therefore set out to provide further evidence about the clinical and economic implications of implant choice when considering hip fracture fixation strategies. A retrospective cohort study using Scottish hip fracture audit (SHFA) data was performed for the period 2016–2022. Patients ≥50 with a hip fracture and treated with IMN or SHS constructs at Scottish Hospitals were included. Comparative analyses, including adjustment for confounders, were performed utilising Multivariable logistic regression for dichotomous outcomes and Mann-Whitney-U tests for non-parametric data. A sub-group analysis was also performed focusing on AO-A1/A2 configurations which utilised additional regional data. Cost differences in Length of Stay (LOS) were calculated using defined costs from the NHS Scotland Costs book. In all analyses p<0.05 denoted significance. 13638 records were included (72% female). 9867 received a SHS (72%). No significant differences were identified in 30 or 60-day survival (Odds Ratio [OR] 1.05, 95%CI 0.90–1.23; p=0.532), (OR 1.10, 95%CI 0.97–1.24; p=0.138) between SHS and IMN's. There was however a significantly lower early mobilisation rate with IMN vs SHS (OR 0.64, 95%CI 0.59–0.70; p<0.001), and lower likelihood of discharge to domicile by day-30 post-admission (OR 0.77, 95%CI 0.71–0.84; p<0.001). Acute and overall, LOS were significantly lower for SHS vs IMN (11 vs 12 days and 20 vs 24 days respectively; p<0.001). Findings were similar across a sub-group analysis of 559 AO A1/A2 fracture configurations. Differences in LOS potentially increases costs by £1230 per-patient, irrespective of the higher costs of IMN's v SHS. Appropriate SHS use is associated with early mobilisation, reduced LOS and likely with reduced cost of treatment. Further research exploring potential reasons for the identified differences in early mobilisation are warranted

The hip fracture burden on health and social care services in Scotland is anticipated to increase significantly, primarily driven by an ageing population. This study forecasts future hip fracture incidence and the annual number of hip fractures in Scotland until 2029. The monthly number of patients with hip fracture aged ≥ 50 admitted to a Scottish hospital between 01/01/2017 and 31/12/2021 was identified through data collected by the Scottish Hip Fracture Audit. This data was analysed using Exponential Smoothing and Auto Regressive Integrated Moving Average forecast modelling to project future hip fracture incidence and the annual number of hip fractures until 2029. Adjustments for population change were accounted for by integrating population projections published by National Records of Scotland. Between 2017 and 2021 the annual number of hip fractures in Scotland increased from 6675 to 7797, with a respective increase in hip fracture incidence from 313 to 350 per 100,000. By 2029, the averaged projected annual number of hip fractures is 10311, with an incidence rate of 463 per 100,000. The largest percentage increase in hip fracture occurs in the 70-79 age group (57%), with comparable increases in both sexes (30%). Based upon these projections, overall length of stay following hip fracture will increase from 142713 bed days per annum in 2021, to 203412 by 2029, incurring an additional cost of over £25 million. Forecast modelling demonstrates that the annual number of hip fractures in Scotland will rise substantially by 2029, with considerable implications for health and social care services

COVID-19 confers a three-fold increased mortality risk among hip fracture patients. The aims were to investigate whether vaccination was associated with: i) lower mortality risk, and ii) lower likelihood of contracting COVID-19 within 30 days of fracture. This nationwide cohort study included all patients aged >50 years with a hip fracture between 01/03/20-31/12/21. Data from the Scottish Hip Fracture Audit were collected and included: demographics, injury and management variables, discharge destination, and 30-day mortality status. These variables were linked to population-level records of COVID-19 vaccination and testing. There were 13,345 patients with a median age of 82.0 years (IQR 74.0–88.0), and 9329/13345 (69.9%) were female. Of 3022/13345 (22.6%) patients diagnosed with COVID-19, 606/13345 (4.5%) were COVID-positive within 30 days of fracture. Multivariable logistic regression demonstrated that vaccinated patients were less likely to be COVID-positive (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.34–0.48, p<0.001) than unvaccinated patients. 30-day mortality rate was higher for COVID-positive than COVID-negative patients (15.8% vs 7.9%, p < 0.001). Controlling for confounders (age, sex, comorbidity, deprivation, pre-fracture residence), unvaccinated patients with COVID-19 had a greater mortality risk than COVID-negative patients (OR 2.77, CI 2.12–3.62, p < 0.001), but vaccinated COVID19-positive patients were not at increased risk (OR 0.93, CI 0.53–1.60, p = 0.783). Vaccination was associated with lower COVID-19 infection risk. Vaccinated COVID-positive patients had a similar mortality risk to COVID-negative patients, suggesting a reduced severity of infection. This study demonstrates the efficacy of vaccination in this vulnerable patient group, and presents essential data for future outbreaks

Hip fracture represents a significant challenge, placing increasing pressure on health and social care services in Scotland. This study establishes the ‘historic’ hip fracture burden, namely, the annual number of hip fractures in Scotland, and respective incidence, between 2017 – 2021. Furthermore, the ‘projected’ hip fracture burden and incidence from 2022 – 2029 was estimated, to inform future capacity and funding of health and social care services. The number of individuals with a hip fracture in Scotland between 2017 and 2021 was identified through the Scottish Hip Fracture Audit, enabling the annual number of hip fractures and respective incidence between 2017 – 2021 to be calculated. Projection modelling was performed using Exponential Smoothing and Auto Regressive Integrated Moving Average to estimate the number of hip fractures occurring annually from 2022 – 2029. A combined average projection was employed to provide a more accurate forecast. Accounting for predicted changes within the population demographics of Scotland, the projected hip fracture incidence up to 2029 was calculated. Between 2017 and 2021 the annual number of hip fractures in Scotland increased from 6675 to 7797 (15%), with an increase in incidence from 313 to 350 per 100,000 (11%) of the at-risk population. Hip fracture was observed to increase across all groups, notably males, and the 70–79 and 80–89 age cohorts. By 2029, the combined average projection estimated the annual number of hip fractures at 10311, with an incidence rate of 463 per 100,000, representing a 32% increase from 2021. The largest percentage increase in hip fracture by 2029 occurs in the 70–79 and 80–89 age cohorts (57% and 53% respectively). Based upon these projections, overall length of hospital stay following hip fracture will increase by 60699 days per annum by 2029, incurring an additional cost of at least £25 million. Projection modelling demonstrates the annual number of hip fractures in Scotland will increase substantially by 2029, with significant implications for health and social care services. This increase in hip fracture burden and incidence is influenced strongly by changing population demographics, primarily an ageing population

Hip fracture care is complex multi-disciplinary. We hypothesise that quality of care is affected by variance in resources between ‘in-hours’ (Monday-Friday, 0800–1700) and ‘out-of-hours’ services. This prospective multicentre national cohort study assessed quality of care by evaluating adherence to the evidence-based Scottish Standards of Care for Hip Fracture Patients. Data was collected by the Scottish Hip Fracture Audit for 15174 patients admitted to any of 22 Scottish hospitals from January 2014-April 2018. 11197/15174 (73.8%) patients were admitted out-of-hours. They were significantly less likely to meet the following Standards: ED Big-6-Bundle (OR 0.85, p= 0.002); Time in ED <4 hours (OR 0.76, p< 0.001); avoidance of repeated fasting (OR 0.80, p< 0.001), and avoidance of prolonged fluid fasting (OR 0.83, p< 0.001). Out-of-hours admissions were more likely to receive: geriatric assessment <3 days (OR 1.16, p< 0.001); OT input <3 days (OR 1.10, p= 0.013), and PT input <2 days (OR 1.44, p< 0.001). There were no significant differences for: Time to Theatre <36 hours; Inpatient Care Bundle <24 hours, and Post-op Day 1 Mobilisation. Quality of hip fracture care is affected by time of admission. ED care is poorer out-of-hours, which may reflect limited resources, and out-of-hours admissions are more likely to be excessive fasted excessively. Weekday in-hours admissions are less likely to receive geriatric and allied health professional input in the days following admission, which may reflect the reduced weekend services. Examination of out-of-hours service organisation is required for the pursuit of consistent, equitable care for hip fracture patients

Introduction: We investigated the incidence, risk factors and outcome of acute renal dysfunction (ARD) in patients with a fractured neck of femur. Methods: 170 consecutive patients were prospectively included in the Scottish hip fracture audit database and retrospectively analysed. Historically, lack of consensus definition hindered accurate reporting of ARD. We defined ARD using the ‘RIFLE’ criteria recently described by the Acute Dialysis Quality Initiative (ADQI) Group. Results: 27 patients (16%) developed ARD. Risk factors were male sex, vascular disease, hypertension, diabetes, chronic kidney disease and pre-morbid use of nephro-toxic medications (p< 0.01). Inpatient, 30 and 120 day mortality was higher in the ARD group 19%, 22% and 41% respectively, versus 0%, 4% and 13% in the non-ARD group (p< 0.01) Length of hospital stay was significantly longer in the ARD group; 20 days compared to 13 days for patients in the non-ARD group (p< 0.01). Pre and post-operative complications were 12 and 5 times more frequent respectively in the ARD group (p< 0.01). Discussion: Acute renal dysfunction is an important adverse event in this population. Awareness of risk factors and serial measurements of renal function will enable early identification and focused monitoring of these patients

The Scottish Hip Fracture Audit (. 1. ) was founded on Rikshoft, the Swedish hip fracture register (. 2. ), and since 1993 has documented case-mix, process and outcomes of hip fracture care in Scotland. Evidence-based national guidelines on hip fracture care were updated by a multidisciplinary group in 2002(. 3. ). And hip fracture serves as a tracer condition by the health quality assurance authority for its work on older people, which reported in 2004 (. 4. ). Audit data are used locally to document care and support and monitor service developments. Synergy between the guidelines and the audit provides a means of improving care locally and monitoring care nationally. External review by the quality assurance body shows to what extent guideline-based standards relating to A& E care, pre-operative delay, multidisciplinary care and audit participation are met. Three national-level initiatives on hip fracture care have delivered: reliable and largescale comparative information on case-mix, care and outcomes; evidence-based recommendations on care; and nationally accountable standards inspected and reported by the national health quality assurance authority. These developments are linked and synergistic, and enjoy both clinical and managerial support. They provide an evolving framework for clinical governance and quality assurance, with methods for casemix-adjusted outcome assessment for hip fracture care also now developed

BACKGROUND. Since 1996, the Scottish Hip Fracture Audit (SHFA) group have published reports on the outcomes of patients with hip fractures. In the 2008 report, the group outlined the target standard that “98% of medically fit patients who have sustained a hip fracture should be operated on within 24 hours of ‘safe operating time’ (i.e. between 8 am and 8pm, seven days a week).”. 1. . AIM. We aim to investigate the compliance of our unit to the SHFA target standard. METHODS. We prospectively examined patients who were admitted with hip fractures between 1. st. April to 31. st. July 2011. These included admissions from A&E and inpatients. Patients who did not receive surgical treatment were excluded. Information was collected using the same pro forma as the SHFA group. RESULTS. There were 72 patients with hip fractures in that period. One patient (1.4%) was considered unfit for surgery and therefore excluded. Sixty-five patients were considered fit for surgery on first assessment and 61 (93.8%) had surgery within the target time. There were three patients (4.6%) whose diagnosis was delayed waiting for MRI. The waiting period included a weekend in two patients, when there were no MRI facilities. Only one patient (1.5%) had surgery delayed due to lack of theatre availability. DISCUSSION. Having surgery performed as early as possible is associated with a beneficial impact on morbidity, complications and length of hospital stay. 2–4. , reflected with SIGN guidelines stating “surgery should be performed as soon as the medical condition allows”. 5. and NICE recommending surgery within 48 hours of admission. 6. . CONCLUSION. Although our rate of 93.8% does not meet the target standard, it represents an improvement from the published rate (91.2%) in 2008. It also highlights the areas for improvement in patient care, particularly in getting MRIs swiftly to avoid delays

Hip fracture is a common and serious injury affecting the elderly. Many patients have co-morbidities which may need to be investigated and treated before surgery but, conversely, delay in surgical management of these patients leads to increased morbidity and mortality. The Scottish Hip Fracture Audit (SHFA). 1. conducted in 2007 showed variations between hospitals in postponement rates for medical reasons. The report referred to 11 major clinical abnormalities described by McLaughlin. 2. that were associated with poor postoperative outcomes and should be corrected before surgery. This prospective audit took place in Monklands hospital for a duration of 6 weeks. All patients admitted to the orthopaedic firm from 14. th. Oct 2012 to 26. th. November 2012 with confirmed fracture neck of femur were prospectively included in the audit. A detailed review of the notes took place to identify whether delays were appropriate according to McLaughlin. There were a total of 23 patients admitted during the audit period of which 21 were operated on and 2 patients treated conservatively. The mean age of this cohort was 82.8 (range 55–91) with a male to female ratio of 1:1.3. Sixteen cases (76%) were operated on within 48 hours of admission (11 cases – 52% within 24 hours). Five cases (24%) were delayed by more than 48 hours. Three cases (14%) were delayed due to lack of theatre time. Two patients (9.5%) were delayed due to request of ECHO for ?new murmur. Our practice of managing hip fracture patients is similar to other units in Scotland with a deferral rate of approximately 25%. The patients who have a major clinical abnormality were appropriately investigated and treated before the surgery. Further improvement in management of the theatre time is needed as surgery is delayed for >24 hours in approximately 15% of medically fit hip fracture patients

Troponin I is a widespread used blood test to confirm myocardial damage, usually attributable to myocardial infarction. Troponin tests require to be taken 12 hours after the initial event, and thus may be a potential cause for delay. SIGN and Hip Fracture Audit guidelines recommend 98% of patients obtaining surgery within 24hrs of admission. A population of 347 neck of femur patients presenting to Glasgow Royal Infirmary were assessed over a one year period. 44 (13%) Patients were identified as having a pre-operative Troponin I test. Retrospective case note review of this patient cohort who had pre operative troponin testing was undertaken to identify timing of TnI testing, admission, surgery and medical comorbidies. Time to theatre was compared with the 24hr guideline. From the cohort, 32 Patients had case notes which were located, of which 4 had no filed notes from the admission giving a 28 patient sample population. 18 (64%) had a Troponin of ‘negative’ value (<0.04 μg/l) of which the mean delay to theatre from admission was 46.4 hrs (median 44.5hrs). All 18 breached the 24hr target, 5 were delayed >48hrs. Of the 10 ‘postive’ patients, mean TnI was 0.4 and time to theatre was 85hrs (median 69hrs) with one excluded as treated conservatively. Only one patient was treated within the 24hr target (3.7% of sample group treated operatively) p=<0.001. Scottish Hip Fracture Audit shows GRI to have an overall 98.6% compliance with the 24hr target. The data presented shows significant (near complete) failure to meet the 24hr target in patients tested preoperatively for Troponin I. Almost three-quarters of these patients have normal TnI, but delay may be attributable to additional comorbidities

Background: Hip fracture is a serious injury mainly affecting the elderly population. The injury has a high mortality of 30% at 1 year and also has a major impact on the quality of life of the survivors. The Scottish Hip Fracture Audit has identified significant difference in the level of care provided in hip fractures between different hospitals and regions. The study aims to assess the impact of the experience of the operating surgeon on the long term outcome of hip fractures taking a cemented bipolar hip arthroplasty as an index procedure. Materials and Methods: All patients who had the index procedure carried out over an eight year period at the Dumfries and Galloway Royal Infirmary were included in the study. Their preoperative mobility and health status along with the experience of the surgeon performing the procedure were determined. The outcome assessment was carried out using a modified Harris hip score. Results: 46 patients were followed up at a mean of 45 months (range 16 to 109). One patient required a revision for aseptic loosening. Of the remaining, 18 procedures were carried out by consultant surgeons and 27 by trainees unsupervised. There was no statistical difference in the age, sex, ASA grade, preoperative mobility level or duration of follow up between the two groups of patients. The mean hip score at the time of follow up for the consultant group was 67.2 and 52.6 for the trainee group. This was statistically significant with a P value < 0.05. Conclusion: The proportion of hip fracture surgeries done by, or under the direct supervision of a consultant orthopaedic surgeon vary widely between various Scottish hospitals (20% to 90%). The significant difference in long term out come of the procedure based on the surgeon’s experience calls for greater supervision and training of juniors

Background. Hip fracture in the elderly has high morbidity and mortality. National guidelines have recommended low molecular weight (LMW) heparin or aspirin for thromboprophylaxis in hip fracture. Unlike other types of major surgery, there is a lack of trial evidence for graduated elasticated compression (GEC) stockings in hip fracture patients. Objective. To explore the effect of thromboprophylaxis on survival in hip fracture patients. Participants. 8470 Scottish Hip Fracture Audit (SHFA) participants aged 60 years and over, admitted 1998-2003. Methods. SHFA records were linked to routinely collected hospital discharge and death records occurring within one year of hip fracture admission. Cox proportional hazards regression was used to adjust for age, gender, previous hospital admissions, previous walking ability and residence, American Society of Anesthesiologists grade, fracture type, pressure sores prior to surgery, and delay to surgery. Results. 2531 (30%) patients died within one year of hip fracture admission. GEC stockings appeared to be protective against death (hazard ratio 0.88, 95% confidence interval 0.80-0.97) as did aspirin (HR 0.85, 95% CI 0.76-0.95). However heparin did not appear to protect against death (HR 0.97, 95% CI 0.87-1.08), even when only LMW heparin was included in the analysis. Overall, 3318 (39%) patients were given GEC stockings, 2735 (32%) aspirin, and 4527 (53%) heparin. Patients commonly received more than one type of thromboprophylaxis. Conclusions. This study provides evidence for a protective effect of GEC stockings and aspirin following hip fracture, but not heparin. The study design allowed sophisticated analysis, adjusting for a number of functional, social, surgical, anaesthetic and medical factors. The findings may however be explained by other confounding factors not included in the analysis. These findings suggest that a randomised controlled trial of GEC stockings, aspirin and heparin in hip fracture patients is warranted

The Scottish Hip Fracture Audit started in four hospitals in 1993. To date, all except two, hospitals doing hip fractures have been involved in the audit. Participation has been intermittent due to a lack of funds to pay for the audit staff. Nonetheless there are now 19,000 patients recorded on the database. This allows individual hospitals to compare their workload over time and to compare local data with national comparators. Unfortunately many of the outcome parameters involve soft end points such as the delay in operation or the proportion of patients who are sent for formal rehabilitation. Much of the data has simply confirmed what surgeons have always suspected. The injury is becoming more common, the patients are getting older and the patients are becoming less fit. Co-morbidities are frequent and the strongest predictor of mortality is the age of the patient at presentation. What the audit has done from a surgeon’s viewpoint is to define the general lack of resources devoted to this injury and to provide evidence which has been used in many hospitals particularly to increase the availability of operating time. Equally as no surprise comes the realisation that surgery is often the least part of the care of these patients. Evidence from the audit has allowed many hospitals to encourage greater participation by geriatricians in the overall care of these patients. The use of the specialist nurse in hip fractures who has responsibility for all aspects of care including follow up has been particularly useful and is recommended in all units. There are however, two huge problems arising from this data. The first, is that the existence of the data means there is something which can be measured and in consequence this has been used as a management tool to measure performance yet where hospitals have been found lacking, resources have not always been made available to improve performance. The second and newer problem relates to the existing anonymity of data. At present the system is very much like critical incident reporting in the airline industry and no surgeon, anaesthetist or hospital is individually identified in any of the published data. The Freedom of Information Act, which has recently come into force in the UK, may now make is possible for anyone to obtain individual named data on both doctors and hospitals. While threatening, this development now seems inevitable but may discourage full participation in future audit. In spite of these concerns individual clinicians remain enthusiastic about the audit and England, Wales and Northern Ireland have shown considerable interest in developing the audit into a UK wide system

Hip fracture is a common serious injury in the elderly. Between 1982 and 1998 the number of hip fractures reported annually in Scotland in patients over 55 years rose from 4,000 to 5,700. The optimum method of treatment for the various fracture types remains in contention. We compare outcome measures between displaced, intracapsular fractures in patients over 70 years fixed with cannulated screws and sliding hip screw with side plate. Between 1998 and 2005 a total of 30,482 patients were reviewed by the Scottish Hip Fracture Audit (SHFA). Of these 15,823(53.3% of the total) had sustained intracapsular fractures. 13,587 of these occurred in patients aged 70 or over. Of these 2,428 had undisplaced and 11,159 displaced fractures. Chi test statistical analysis compare outcome measures in this group of displaced intracapsular fractures with respect to aspects of early failure. 534(3.9%) of patients were treated conservatively. 509 (4.7%) fractures were fixed using cannulated screws and 499 (4.6%) using a sliding hip screw. Readmission within 120 days for any cause occurred in 62 patients(14.1%) treated with cannulated screw fixation and in 63 patients(15.7%) for those treated with a sliding hip screw(P=0.509). Of these 36 patients(8.2%) in the former and 23 patients(5.7%) in the latter group were readmitted for complications related to hip fracture(P=0.033). Mortality within this period included 69 patients(13.5%) in the CS and 98(19.6%) in the SHS group. In terms of re-operation within 120 days of the original admission, 53 patients(10.6%) receiving cannulated screws compared to 24 patients(4.8%) treated with a sliding hip screw requiring further surgery(P=0.0006). The fracture was seen to displace in 12(22.6%) patients originally treated with cannulated screws compared to 6 patients(25%) treated with sliding hip screw(P=0.156). More significantly the fixation device was seen to have migrated in 24(45.3%) of the cannulated screw as compared to 7(29.2%) patients in the sliding hip screw group(P=0.002). Periprosthetic fractures were recorded in 4(7.5%) of the former and 3(12.5%) in the latter group(P=0.708). Wound infection was higher in the SHS group(2 patients) as compared to the screw fixation group(1 patient)(P=0.565). Statistical analysis demonstrates a dramatic difference exists between these 2 fixation types in terms of re-operation within 120 days of the original admission for which published literature has previously only recorded biomechanical, in vitro comparisons. Data regarding specific implant factors such as number of screws, position, configuration, starting point, thread length and use of washers in cannulated screws, and position, tapping, supplementary screw and compression screw in sliding hip screws was not recorded and may be considered to bias our results

Hip fracture is a common serious injury in the elderly. Between 1982 and 1998 the number of hip fractures reported annually in Scotland in patients over 55 years rose from 4,000 to 5,700. The optimum method of treatment for the various fracture types remains in contention. The purpose of this study was to compare outcome measures between displaced, intracapsular fractures in patients over 70 years fixed with cannulated screws and sliding hip screw with side plate. Between 1998 and 2005 a total of 30,482 patients were reviewed by the Scottish Hip Fracture Audit (SHFA). Of these 15,823(53.3% of the total) had sustained intracapsular fractures. 13,587 of these occurred in patients aged 70 or over. Of these 2,428 had undisplaced and 11,159 displaced fractures. We performed a Chi test statistical analysis comparing outcome measures in this group of displaced intracapsular fractures with respect to aspects of early failure. 534(3.9%) of patients were treated conservatively. 509 (4.7%) fractures were fixed using cannulated screws and 499 (4.6%) using a sliding hip screw. Readmission within 120 days for any cause occurred in 62 patients(14.1%) treated with cannulated screw fixation and in 63 patients(15.7%) for those treated with a sliding hip screw(P=0.509). Of these 36 patients(8.2%) in the former and 23 patients(5.7%) in the latter group were readmitted for complications related to hip fracture(P=0.033). Mortality within this period included 69 patients(13.5%) in the CS and 98(19.6%) in the SHS group. In terms of re-operation within 120 days of the original admission, 53 patients(10.6%) receiving cannulated screws compared to 24 patients(4.8%) treated with a sliding hip screw requiring further surgery(P=0.0006). The fracture was seen to displace in 12(22.6%) patients originally treated with cannulated screws compared to 6 patients(25%) treated with sliding hip screw(P=0.156). More significantly the fixation device was seen to have migrated in 24(45.3%) of the cannulated screw as compared to 7(29.2%) patients in the sliding hip screw group(P=0.002). Periprosthetic fractures were recorded in 4(7.5%) of the former and 3(12.5%) in the latter group(P=0.708). Wound infection was higher in the SHS group(2 patients) as compared to the screw fixation group(1 patient)(P=0.565). Statistical analysis demonstrates a dramatic difference exists between these 2 fixation types in terms of re-operation within 120 days of the original admission for which published literature has previously only recorded biomechanical, in vitro comparisons. Data regarding specific implant factors such as number of screws, position, configuration, starting point, thread length and use of washers in cannulated screws, and position, tapping, supplementary screw and compression screw in sliding hip screws was not recorded and may be considered to bias our results

Aims

The aims of this study were to evaluate the incidence of reoperation (all cause and specifically for periprosthetic femoral fracture (PFF)) and mortality, and associated risk factors, following a hemiarthroplasty incorporating a cemented collarless polished taper slip stem (PTS) for management of an intracapsular hip fracture.

Aims

This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality.

Aims

Delirium is associated with adverse outcomes following hip fracture, but the prevalence and significance of delirium for the prognosis and ongoing rehabilitation needs of patients admitted from home is less well studied. Here, we analyzed relationships between delirium in patients admitted from home with 1) mortality; 2) total length of hospital stay; 3) need for post-acute inpatient rehabilitation; and 4) hospital readmission within 180 days.