A national audit on post-operative weight bearing in adult patients undergoing surgery for lower extremity fragility fractures.
To establish an understanding of the current practice of postoperative weight bearing for lower extremity fragility fractures treated surgically in the UK.
Collect data regarding the postoperative weight bearing instructions for patients undergoing surgery for lower extremity fragility fractures, against the BOA Standard at a local level within healthcare institutions.
Local data to be submitted centrally to be analysed on a regional and national level.
Above BOA Standard, ‘The care of the older or frail orthopaedic trauma patient’, May 2019.
Collaborators in each participating NHS hospital will collect data for two data arms; prospective and retrospective data. No patient identifiable data will be collected. The data collection period for the retrospective arm is from 1st January 2019 to 30th June 2019. The data collection period for the prospective arm will be from 1st February 2021 to 14th March 2021. All adults (age 60 and over) meeting inclusion and exclusion criteria that undergo surgery for lower extremity fragility fractures between these dates will be included. Information on the patient’s age, gender, fracture, operation, surgeon grade, and post-operative weight bearing instructions will be recorded.
All collaborators will be expected to register the audit locally.
% compliance of post-operative instructions with point 14 of BOA standard (weight bearing instructions allow full weight bearing for activities of daily living) will be calculated for each hospital. Hospital-by-hospital variation will be calculated for fracture location and description, type of operation, seniority of operating surgeon and duration of restricted weight bearing.
All collaborators will be expected to ensure the trust data is presented at a local departmental audit meeting.
Step by Step method for collaborators
1) Register for the Audit by signing up via this link: https://forms.gle/4tqsNNKphkiSjgQ96
It takes just a minute – we only need an email address and hospital site to get started.
2) Send details of the following to FFPOMstudy@gmail.com if available:
Guidelines / protocols for management of lower extremity fragility fractures
Any rehab protocols / leaflets relative to fragility fractures
3) Identify a local consultant lead and register the audit with your local audit department. Example audit submissions forms are available in most formats which should help with this – see ‘audit registration template’ document.
4) Identify all adult (age 60 years and above) lower extremity fragility fractures that present to your hospital’s orthopaedic services and undergo surgery, during both the prospective and retrospective data collection periods. Recommendations for this include:
On-call patient admissions list
Theatre log books
5) Then ensure all patients identified meet the inclusion and exclusion criteria, using the flowchart below – patients that do not meet these criteria must not be included.
6) Prospectively collect data during the prospective data collection period (1st February – 14th March 2021). Retrospectively collect data for the retrospective data collection period (1st January 2019 – 30th June 2019). All data to be recorded on the excel data collection sheet (separate tabs for the retrospective and prospective data). Clarification of data points to be collected is included below. Recommended sources of information:
PACS / Radiology systems
Discussion with treating clinician
7) Data collection excel spreadsheet to be emailed to FFPOMstudy@gmail.com by 14th April 2021
Inclusion / exclusion criteria
Age less than 60
High energy injury
Pathological fracture secondary to cancer (primary or metastases)
See the below flow chart for more information:
* a patient will be classified as polytrauma if they have any of the following in addition to their lower limb fracture:
Bilateral lower limb fractures
Upper limb fracture (excluding the hand)
Chest injury (rib fractures, scapula fractures, or any intra-thoracic injury to the chest that requires intervention)
Head injury (intra-cranial event, or fracture to the skull or facial bones)
Spinal injury (an injury to the spinal cord, or spinal fracture/spinal ligamentous injury that requires operative management or restriction to weight bearing / mobility of the spine)
Bradford Royal Infirmary
Brighton General Hospital
Bristol Royal Infirmary
Chelsea and Westminster Hospital
Colchester General Hospital
Connolly Hospital Blanchardstown
Countess of Chester Hospital
Croydon University Hospital
Darlington Memorial Hospital
Diana, Princess of Wales Hospital (Grimsby)
Dorset County Hospital
Frimley Health NHS Foundation Trust
Galway University Hospitals
Glasgow Royal Infirmary
Gloucestershire Royal Hospital
Great Western Hospital, Swindon
Guy's and St Thomas's Hospital
Harrogate District Hospital
Horton General Hospital
James Paget University Hospitals
John Radcliffe Hospital
Leeds General Infirmary
Lincoln County Hospital
Liverpool University Hospital NHS Foundation Trust
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