Hip Fracture - Quality Statement 6: Surgery for Displaced Intracapsular Fractures

Resources Quality Statements Advisory Committee About

Surgery for Displaced Intracapsular Fractures

Patients diagnosed with a displaced intracapsular hip fracture are treated surgically with arthroplasty.

Background

Most patients with a displaced intracapsular fracture should receive surgical arthroplasty because it is associated with lower reoperation rates, fewer patient reports of pain, and better functional and quality-of-life scores compared with internal fixation. In rare cases in which the clinician feels that the patient may benefit from preservation of the hip joint (e.g., patients who are 60 years of age or younger and very active), reduction and fixation may be considered. Younger patients diagnosed with displaced femoral neck fractures who undergo internal fixation may also benefit from expedited surgery (i.e., within 6 hours) due to the potential risk of avascular necrosis.

What This Quality Statement Means

For Patients

Your surgeon should explain which type of surgery is most appropriate for your type of hip fracture.

For Clinicians

If your patient has a displaced intracapsular fracture, they should almost always receive arthroplasty (total arthroplasty or hemiarthroplasty). In rare cases of younger and very active patients, you may consider reduction and fixation to preserve the hip joint.

For Health Services

Ensure that surgeons have access to all resources necessary to perform appropriately selected procedures.

Quality Indicators

Process Indicator

Percentage of patients diagnosed with a displaced intracapsular fracture who undergo arthroplasty (total arthroplasty or hemiarthroplasty)

Denominator: total number of adults diagnosed with a displaced intracapsular fracture who undergo surgery
Numerator: number of people in the denominator who undergo arthroplasty (total arthroplasty or hemiarthroplasty)
Data source: Discharge Abstract Database, local data collection

Evidence to Improve Care