Ban Ilija, Palm Henrik, Birkelund Lasse, Eschen Jacob, Kring Søren, Brix Michael, Troelsen Anders
*Department of Orthopaedics, Aabenraa Hospital, Aabenraa, Denmark; †Department of Orthopaedics, Hvidovre University Hospital, Hvidovre, Denmark; and ‡Department of Orthopaedics, Odense University Hospital, Odense, Denmark.
J Orthop Trauma. 2014 Feb;28(2):e21-6. doi: 10.1097/BOT.0b013e3182a4aa6a.
Reoperations are common after surgical treatment of hip fractures but may be reduced by optimal choice of implant based on fracture classification. We hypothesized that implementing a surgical treatment algorithm was possible in our hospital and would result in a reduced reoperation rate.
Retrospective comparative study.
Provincial level III trauma center.
The evidence-based "Hvidovre Algorithm" for treatment of hip fractures was adopted and implemented at our provincial institution in September 2008. Three hundred eighty-six consecutive patients older than 50 years admitted with a hip fracture in the first year after implementation were prospectively included and compared with 417 retrospectively included similar patients admitted within the last year before implementation.
Implementation of an evidence-based treatment algorithm for hip fracture surgery.
Eighty-five percent (330 of 386) patients were operated according to the algorithm after implementation, compared with 67% (280 of 417) of procedures before implementation (P < 0.001). After implementation, the overall reoperation rate showed a tendency toward a reduction to 8% (32 of 386) from 12% (48 of 417) (P = 0.1). Among all the 803 included patients, the reoperation rate was lower if procedures had been performed according to the algorithm recommendations: 9% (53 of 610) versus 14% (27 of 193) (P = 0.009).
The algorithm for hip fracture surgery was easily implemented, and our results support that using it facilitates a low reoperation rate. The reoperation rate may be further reduced with higher adherence to algorithm recommendation.
Therapeutic level III. See instructions for authors for a complete description of levels of evidence.
髋关节骨折手术治疗后再次手术很常见，但根据骨折分类优化植入物选择可能会降低再次手术率。我们假设在我院实施手术治疗算法是可行的，并且会降低再次手术率。
回顾性比较研究。
省级三级创伤中心。
2008年9月，我院采用并实施了基于循证的“维德夫勒算法”治疗髋关节骨折。前瞻性纳入实施后第一年收治的386例年龄大于50岁的连续髋关节骨折患者，并与实施前最后一年回顾性纳入的417例类似患者进行比较。
实施基于循证的髋关节骨折手术治疗算法。
实施后85%（386例中的330例）的患者按照算法进行了手术，而实施前这一比例为67%（417例中的280例）（P<0.001）。实施后，总体再次手术率呈下降趋势，从12%（417例中的48例）降至8%（386例中的32例）（P = 0.1）。在所有纳入的803例患者中，如果按照算法建议进行手术，再次手术率较低：9%（610例中的53例）对14%（193例中的27例）（P = 0.009）。
髋关节骨折手术算法易于实施，我们的结果支持使用该算法有助于降低再次手术率。更高程度地遵循算法建议可能会进一步降低再次手术率。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
