title: Current practice in the treatment of AO type 31-A2 hip fractures: does sub-specialty and experience of surgeon determine type of fixation?
abstract: BACKGROUND
  Debate surrounds the optimal treatment of AO type 31-A2 fractures of the hip. Two principal treatment modalities are the compression hip screw (CHS) and cephallomedullary device (CMD). The use of CMD's is steadily increasing, for fixation of this fracture type, despite a lack of supportive evidence.
  
  
  METHODS
  100 trauma consultants were asked for their opinion towards treatment of an AO type 31-A2 fracture. Subspecialty and length of time in post were also recorded.
  
  
  RESULTS
  A significant proportion of consultants opted to use a CMD. Consultants who had been in post for a shorter time, and those in specialties other than lower limb were more likely to use a CMD.
  
  
  CONCLUSIONS
  NICE guidelines suggest CHS for AO type 31-A2 fractures.
  
  
  CONCLUSIONS
  CMD accounts for a large percentage of treatment in our study, despite NICE guidelines, and other studies suggest their use is rising. We suggest there is a trend of less experienced consultants, and consultants whose specialties are those other than lower limb, using CMD more often. This may be creating an increased cost burden to the NHS, with no evidence to support their use.
authors.affiliation: Trauma & Orthopaedic Department, North Manchester General Hospital, UK. Electronic address: Davidmurray@doctors.org.uk.
authors.forename: D J
authors.initials: DJ
authors.lastname: Murray
authors.affiliation: Trauma & Orthopaedic Department, North Manchester General Hospital, UK.
authors.forename: G
authors.initials: G
authors.lastname: Foley
authors.affiliation: Trauma & Orthopaedic Department, North Manchester General Hospital, UK.
authors.forename: A
authors.initials: A
authors.lastname: Chougle
mesh_terms: D001858:Bone Nails; D001863:Bone Screws; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004867:Equipment Design; D005593:Fracture Fixation, Internal / Q000379:methods*; D006620:Hip Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011859:Radiography; D012017:Referral and Consultation; D066231:Surgeons / Q000592:standards*
keywords: AO classification; Cephallomedullary device; Compression hip screw; Fracture neck of femur; Intertrochanteric fracture; NICE guidelines