IOA 2022

Policy Treatment of Hip Fractures

דוד לניאדו 1 Shuli Brammli-Greenberg 2 Arie Kandel 1 Meir (Iri) Liebergall 1 Yoram Weil 1 Gurion Rivkin 1
1Department of Orthopedics, Hadassah Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Israel
2Faculty of Medicine, The Hebrew University, Israel

Hip fractures are among the most common fractures in the elderly and as such their surgical procedures are common among orthopedic surgeons. Treatment options differ depending on location, displacement, comminution, and patient characteristics. Although these fractures are common, treatment of them may ignite controversy.

Delphi is a survey method that enables to reach experts in a specific field in order to form a consensus in the point being discussed. This is useful in cases where no evidence-based research is being concrete regarding recommendations. Recurring survey rounds to the same experts may be needed for a consensus to be established. A theoretical hip fracture treatment algorithm was created and using the Delphi method Orthopedic Trauma surgeons and Adult Reconstructive surgeons were surveyed to reach a consensus of hip fracture treatment policy.

Forty-five surgeons from around the world participated in the study, 21 trauma surgeons and 24 adult reconstructive surgeons. Three survey rounds were needed to reach consensus of treatment.

In the first round we were able to reach consensus regarding the treatment of extracapsular fractures, non-displaced intracapsular fractures as well as displaced intracapsular fracture in patients younger than 65.

The 2nd round provided information regarding patients older than 65 presenting with displaced intracapsular fracture. Several patient characteristics lead to recommendation of Total Hip Arthroplasty (THA) or Hemiarthroplasty (HA).

In the 3rd round we challenged patient and fracture characteristics of the 65 and younger patients with displaced intracapsular hip fractures. We believe the arbitrary determination of 65 years of age as decision parameter is not reliable and should not be the only variable taken into consideration in the decision of emergency fracture reduction and fixation.

After the last survey and using the expert opinions a new algorithm was created, including patient and fracture characteristics for treatment recommendation in the cases of most controversy.