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Interpreting and reporting fracture classification and operation type in hip fracture: Implications for research studies and routine national audits

The Bone & Joint Journal Oct 10, 2019

Masters J, et al. - The records were analyzed for 903 cases in order to explore data quality in operation type and fracture classification registered as part of a large research study and a national audit with an independent review. For the subtypes of extracapsular fracture, agreement was poor and most centres attained no better than “fair” agreement. Only four centres failed to have at least “moderate” agreement, when the categorization was settled to a single option for “extracapsular” fracture. For the subtypes of intracapsular fracture only “moderate” agreement which enhanced to “substantial” when settled to “intracapsular” was noted. With “substantial” agreement, subtrochanteric fracture types were well listed. For internal fixation procedures, near “perfect” agreement was noted. When the type of arthroplasty surgery was listed at the level of “hemiarthroplasty” and “total hip replacement”, “Perfect” or “substantial” agreement was attained. For the listed fracture classification, a minimum of 5.2% of cases had “highly improbable” procedures while analyzing data submitted to the National Hip Fracture Database. Hence, at a national scale, the complexity of gathering fracture classification data compromises the exactitude with which descriptive classification systems could be reported. Moreover, data around type of surgery done exhibit comparable tendencies.
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