Hip Fracture - Quality Statement 5: Surgery for Subtrochanteric or Unstable Intertrochanteric Fractures

Resources Quality Statements Advisory Committee About

Surgery for Subtrochanteric or Unstable Intertrochanteric Fractures

Patients diagnosed with a subtrochanteric fracture or unstable intertrochanteric fracture are treated surgically with intramedullary nails.

Background

Lower complication rates are associated with the use of intramedullary nails versus sliding hip screws in the treatment of subtrochanteric and unstable intertrochanteric fractures. When used to treat subtrochanteric fractures, intramedullary nails have been shown to result in fewer cases of fracture fixation failure than sliding hip screws. Further, the use of intramedullary nails in surgery for unstable intertrochanteric fractures has been shown to result in improved mobility and decreased limb shortening when compared to sliding hip screws.

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 subtrochanteric fracture, use intramedullary nails. If your patient was ambulatory before their hip fracture and has an unstable intertrochanteric fracture, use intramedullary nails. If your patient was not ambulatory before their hip fracture and has an unstable intertrochanteric fracture, use a sliding hip screw.

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 subtrochanteric or unstable intertrochanteric fracture who are treated with intramedullary nails

Denominator: total number of adults diagnosed with either a subtrochanteric fracture or an unstable intertrochanteric fracture who undergo surgery
Numerator: number of people in the denominator who receive intramedullary nails
Data source: Discharge Abstract Database, local data collection

Evidence to Improve Care