title: Adherence to a femoral neck fracture treatment guideline.
abstract: OBJECTIVE
  In 2007 the Dutch Surgical Society published a clinical practice guideline for the treatment of hip fracture patients, based on the best available international evidence at that time. We investigated to what extent treatment of femoral neck fracture patients in the Netherlands corresponded with these guidelines, and determined differences in patient characteristics between the treatment groups.
  
  
  METHODS
  All femoral neck fracture patients treated in 14 hospitals between February 2008 and August 2009 were included. Patient characteristics, X-rays, and treatment data were collected retrospectively.
  
  
  RESULTS
  From a total of 1,250 patients 59% had been treated with arthroplasty, 39% with internal fixation, and 2% with a non-operative treatment. While 74% of the treatment choices complied with the guideline, 12% did not. In 14% adherence could not be determined from the available data. Arthroplasty was preferred over internal fixation in elderly patients with severe comorbidity, pre-fracture osteoporosis and a displaced fracture, who were ambulatory with aids pre-fracture (odds ratio, OR 2.2-58.1). Sliding hip screws were preferred over cancellous screws in displaced fractures (OR 1.9).
  
  
  CONCLUSIONS
  Overall guideline adherence was good. Most deviations concerned treatment of elderly patients with a displaced fracture and implant use in internal fixation. Additional data on these issues, preferably at a higher scientific level of evidence, is needed in order to improve the guideline and to reinforce a more uniform treatment of these patients.
authors.affiliation: Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Zielinski
authors.forename: Max A
authors.initials: MA
authors.lastname: Meeuwis
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Heetveld
authors.forename: Michiel H J
authors.initials: MH
authors.lastname: Verhofstad
authors.forename: Gert R
authors.initials: GR
authors.lastname: Roukema
authors.forename: Peter
authors.initials: P
authors.lastname: Patka
authors.forename: Esther M M
authors.initials: EM
authors.lastname: Van Lieshout
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D002648:Child; D002675:Child, Preschool; D005260:Female; D005265:Femoral Neck Fractures / Q000628:therapy*; D005593:Fracture Fixation, Internal; D019983:Guideline Adherence / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019637:Orthopedic Procedures; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D055815:Young Adult