[Trochanteric femur fractures--analysis of external quality assurance within a comprehensive survey].

INTRODUCTION: Trochanteric femur fractures are a typical injury of elderly people and are of significant relevance for their quality of life.

MATERIAL AND METHOD: Data on 7252 proximal femur fractures from the department of external quality assurance of the chamber of physicians of Westphalia-Lippe/Germany were analysed. Topics of interest were: patient profile, type of femur fracture, method of treatment, intra- and postoperative complications, mobility before and after fracture.

RESULTS: 2883 of 7252 proximal femur fractures were trochanteric fractures, 89.9% of which were instable. Trochanteric fractures were either stabilised by extra-medullary implants, e.g. dynamic hip screw (DHS; 57.5%), or by intra-medullary implants, e.g. proximal femur nail (PFN; 38.3%). The following intra-operative complications were reported: bone injury, vessel injury, nerve injury, others. Intra-medullary implants caused nearly twice as many complications as DHS (1.8% vs. 1.1%; chi-square test, p < 0.01). Specialised orthopaedic trauma departments (1.7%) had fewer complications than non-specialised units (2.2%) (chi-square test, p < 0.001). Mobility after intra- and extra-medullary fixation was comparable. At the time of discharge, 58% of patients were able to walk with crutches. High-volume hospitals (151 - 175 patients) performed significantly better than low-volume hospitals (1 - 25 patients) concerning mortality and intra- and postoperative complications. However, it is not possible to infer good quality from high volume alone, because some low-volume hospitals showed excellent results.

CONCLUSION: Treatment of trochanteric femur fractures is relatively safe. Extra-medullary implants can be used for instable trochanteric fractures with good results.