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Background: Whereas the Scottish guidelines are audited annually, nobody evaluates guideline compliance in Germany. Thus, can external quality assurance data pursuant to section 137 of the German Social Code Book V be suitable for auditing guideline compliance?, Materials and Methods: From North Rhine Westphalia, a total of 48,831 cases of femoral fractures near the hip joint were evaluated. Compliance with the guidelines was determined based on preoperative hospital stay, thrombosis, and antibiotic prophylaxis. Guideline rationale was reviewed in terms of mortality and thromboembolism rate., Results: Sixty-four percent of the interventions were performed in a timely manner. Thrombosis prophylaxis was given in 99% of cases. Antibiotics were given as a single shot. There was no connection between mortality and thromboembolism rates or time to surgery., Conclusion: Guideline compliance is similar in German and Scotland. The external quality assurance data are suitable for evaluating guideline compliance. The literature recommends a short time to surgery. Given the short observation period, it was not possible to demonstrate any improvement in outcomes.

Fracture of the femoral neck is a common problem in elderly patients. In these patients with concomitant illness and medical complications the hip fracture is then often the reason for a long-term institutionalization with serious implications for the outcome. While the treatment of displaced femoral neck fractures Garden's stage III and IV is quite clear, the procedure for impacted or undisplaced fractures Garden's stage I or II is still the subject of controversy. In a retrospective study was shown that conservative treatment of impacted or undisplaced femoral neck fractures is associated with a high complication rate of 30-40%. When these femoral neck fractures were broken down according to Garden's classification the complication rate in cases of Garden's stage II was found to be 1.5 times that in femoral neck fractures in Garden's stage I. With a P-value less than 0.05 this difference was statistically significant (Wilcoxon test). Because of these major problems associated with conservative treatment we changed our current algorithm. Covered internal fixation with cancellous screws is now considered to be indicated for all impacted or undisplaced femoral neck fractures. Between 1990 und 1992, 53 patients (42 female, 11 male) with femoral neck fracture in Garden's stage I (24 patients) or II (29 patients) were treated in our Department of Traumatology with 6.5 mm cancellous screws. In all case early mobilization and weight-bearing were allowed. In this prospective study the average follow-up was 14.3 +/- 2.1 months (range 8-20 months).(ABSTRACT TRUNCATED AT 250 WORDS)

The results obtained in 167 extracapsular fractures of the hip are presented. Ender's pins were used in 82 cases and the dynamic hip screw (DHS) in 85. Comparison of different aspects (handling, postoperative mobility, complication rate, mortality) shows that the second operating procedure named DHS is highly suitable for the treatment of fractures A1-A3 and B2 (Müller classification) and superior to the procedure with Ender's pins.

The authors report on the results obtained with surgical treatment of 470 femoral neck fractures, which they analyzed with reference to the type of break. The found that a fracture line with a zig-zag course signified the best prognosis for both healing and stability, whereas fractures with a posterior fragment had a poorer prognosis. The results support the urgency of the operation and confirm the higher proportion of cases treated for jagged fractures among those with good results.