Current concepts for treating proximal femur fractures in Europe

A. Scola & N. Haas & U. Stöckle & P. Giannoudis & J. C. Bel &
M. S. Larsen & C. Candrian & J. M. Munoz-Vives &
F. Gebhard

Abstract
Introduction Proximal femur fractures (PFFs) are frequent
injuries in the elderly patient population of every trauma
centre. This type of facture represents the most important
socio-economic impact of osteoporosis. A European standard
of care has not been established yet.
Material and methods The aim of the study is to evaluate the
standards in treatment of this fracture within the EFORT (European
Federation of National Associations of Orthopaedics and
Traumatology). Within the annual congress 2013 and online
EFORT home page, 581 surgeons were asked by a questionnaire.
The PFF treatment Europe survey focused on training of the
surgeons as well as the number of proximal femur fractures
treated in their hospitals and by themselves. Furthermore, the
survey consisted of five different cases of a PFF. Each fracture
had to be classified by the AO (Arbeitsgemeinschaft für
Osteosynthese) classification. After that, the decision for operative
or non-operative treatment had to be made. The implant for
this type of fracture had to be chosen. At the end of each case, a
postoperative X-ray with an osteosynthesis according to AO/
ASIF (Association for the Study of Internal Fixation) was shown
and the surgeons had to decide whether they agree to the
treatment.
Results In a case of AO/ASIF-type B3 fracture, 73.72 % of the
surgeons classified it correctly, 82.78 % in a case of AO/ASIFtype
B1 fracture, 26.86 % in a case of A1 fracture (due to the
missing second plane), 63.70 % in a case of A3 fracture and
95.18%in a case of A1 fracture, respectively. The treatment was
agreed with in the following: 74.14%in a case of B3, 89.33%in
a case of B1, 63.72 % in a case of B2, 86.73 % in a case of A3
and 93.09 % in a case of A1 fracture.
Conclusion In conclusion, the current European system of
education and training in combination with the increasing
cooperation between the countries has improved the overall
understanding of PFF fracture patterns. Although there are
still regional differences in the treatment of PFF, the major
principles in addressing PFF throughout Europe are meanwhile
more congruent than those two decades ago. The study
proves a successful implementation of the topic “trauma”
within the European education course concepts.