Comparison of Hip Fracture Treatment in Finland, Great Britain and Sweden with Special Reference to Evaluation Methods

The treatment of hip fractures in the elderly has been under debate for decades. There is a lack of standardisation of treatment and rehabilitation and also concerning the measurements and follow-up times in studies on treatment. Two patient series with cervical hip fractures treated with Austin Moore hemiarthroplasty in Finland and hook pin osteosynthesis in Sweden were compared using matched-pair analysis in view of different age groups. Hip fracture treatments in six hospitals in Finland and one in Great Britain were surveyed. The adequacy of a short four-month follow-up was studied by comparing outcomes at four months and one year. Standardised Audit of Hip Fractures in Europe data collection sets were tested and used in three studies. Osteosynthesis resulted in lower one-year mortality but a higher reoperation rate in patients aged 55–75 years and was associated with a lesser need for walking aids, less pain and lower four-month mortality in patients aged 76–80 years. There were some differences in the patient characteristics and the methods of treatment between Great Britain and Finland. In Great Britain, more patients returned to their own homes, but one-year mortality after trochanteric fractures was higher. Hip fracture treatments and outcomes were quite similar between the six Finnish hospitals. There was a slight difference in adjusted postoperative mobility and mortality in two hospitals compared to the others. Six of the ten functional domains and residential status remained unchanged, while walking ability and four functional domains improved between four months and one year. The standardised data set was a practical and reliable way to acquire a great variety of information on hip fracture patients, treatments and outcomes. Hook pin osteosynthesis can be recommended for patients with cervical hip fractures younger than 80 years, whereas older patients can also be safely treated with Austin Moore hemiarthroplasty. The characteristics and outcomes of hip fracture patients were rather similar between Finland and Great Britain and between the different Finnish hospitals irrespective of the variety of methods used in treatment. Standardised Audit for Hip Fractures in Europe is a reliable data collection set and suitable as a basis of hip fracture surveys, audits and registers. Four-month follow-up is justified as the shortest feasible alternative in studies on rehabilitation and residential status after hip fractures.