Immediately after each primary operation and reoperation for hip fracture, surgeons complete a one-page paper form that is sent to the register. The NHFR has collected data on hip fracture patients operated at Norwegian hospitals since 2005. The aim of this study was, by use of the NHFR dataset, to investigate the ability of orthopaedic surgeons to identify pathologic hip fractures in an acute setting and secondly to validate the reported underlying cause of the pathologic fractures reported to the NHFR from 2005 to 2019. Consequently, there has been some uncertainty as to whether the underlying diagnose of a pathologic fracture reported to the NHFR is correct. The exact diagnose can sometimes not be made until results from intra-operative biopsies are available, often several weeks after surgery. Registration of pathologic fractures is problematic since orthopaedic surgeons may have problems deciding whether a fracture is pathologic or not in the acute setting at the time of surgery. Pathologic hip fractures are also reported to the NHFR, but as up to today, these fractures have been excluded from all studies. The Norwegian Hip Fracture Register (NHFR) has collected data and evaluated treatment of all hip fractures in Norway since 2005. The data on pathologic hip fractures, however, are sparse despite it is the most frequently operated pathologic fracture. Įxtensive research on osteoporotic hip fractures has resulted in several evidence-based guidelines for improving treatment. The significant mechanical stress during weight load results in pain and a high risk of pathologic fractures in this location. The proximal femur is the most common location of metastases in the appendicular skeleton. Skeletal metastases are a major problem for cancer patients with disseminated disease leading to pain and immobility, and proper treatment is of great importance for improving quality of remaining life. The corrected data on pathologic fractures in the NHFR from 2005 to 2019 can now be a valid resource for further studies on the subject. Orthopaedic surgeons in Norway failed to report correct data on pathologic fractures and the corresponding cancer diagnosis in an acute setting in many patients. The true rate of pathologic hip fractures secondary to malignancy in our material was 0.8%, and most patients had underlying prostate (30%), breast (20%), or lung (17%) cancer. The underlying diagnosis reported was corrected in 442 of the 999 patients. The remaining 984 patients had a pathologic fracture secondary to malignancy. When reviewing the 999 validated pathologic fractures, 15 patients had a pathologic fracture secondary to a benign lesion. Of the 1484 fractures possible secondary to malignancy, 485 (32.7%) were not a pathologic fracture. Based on this validation, information in the NHFR was corrected, whenever necessary. Pathology reports were reviewed once a biopsy had been performed. These fractures were thoroughly validated by reviewing X-rays, the patient journal, the operation description for date, side, why there had been suspicion of pathologic fracture, and implant choice. In the NHFR dataset between 20, we identified 1484 fractures reported to be pathologic possibly secondary to a malignancy. The aim of this study was to investigate the ability of orthopaedic surgeons to identify pathologic hip fractures in an acute setting and secondly to validate the underlying cause of the pathologic fractures reported to Norwegian Hip Fracture Register (NHFR). ![]() ![]() Data on pathologic hip fractures, however, are sparse despite it is the most frequently operated pathologic fracture. ![]()
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