Fractured Neck of Femur Service University Hospital of North Staffordshire

A fractured neck of femur is a very serious and in some cases, life threatening trauma, affecting the most frail and vulnerable people in the community. 

Under the leadership of   Mr Philip Roberts, Consultant Orthopaedic Surgeon the Trust has been key in transforming the treatment for fractured neck of femur service in North Staffs The University Hospital of North Staffordshire is one of the leading UK Trusts with its care pathway, pioneering techniques, and its success in reducing the mortality and infection rates amongst this group of mainly elderly patients.

Treating nearly 550 patients a year, our fractured neck of femur service, lead by Mr Roberts has significantly improved the mortality rate for patients, (surviving a year after surgery) in the last 5 years, from the national average of approximately 12% down to 6% in North Staffordshire. 

Mr Roberts said : “Breaking the femur is not an uncommon injury but potentially life threatening for a patient, particularly amongst the fragile and elderly, after all, it is the biggest bone in the human body.  Here in North Staffordshire our fractured neck of femur patients are treated by a dedicated specialist multi-disciplinary team from the point of entry in the Emergency Department.  We believe that this group of patients, who are some of the most vulnerable within our community, have a greater chance of making a good recovery following this type of trauma if they receive care and treatment that is focussed and of the highest standard.

Over the last 5 years we have looked at how we treat these patients, maximised on the utilisation of dedicated operating theatre slots and developed a multi-disciplinary team working approach to how we manage these patients, which includes Consultant Orthopaedic Surgeons, Geriatricians, Anaesthetists, Specialist Nurses, Physiotherapists, Occupational Therapists and Infection Control Nurses.

Trauma patients with a fractured neck of femur are elderly, fragile people who quite often have suffered an acute medical episode such as heart attacks, strokes or trans-ischemic attacks. They are sometimes suffering from other underlying health conditions such as vascular disease, diabetes or dementia, and the approach we have developed in the Trust is designed to ensure they get the right care and treatment for these conditions, and that they have the right coping mechanisms in place to support then when they return home”.

The risk of infection amongst this group of patients is usually high, however, in North Staffordshire we are again leading the way in reducing the risk of MRSA and Clostridium difficile for patients.  With a ‘search and destroy’ approach to screening and antibiotic prescribing our fractured neck of femur patients are also receiving a pioneering new infection busting technique.  Mr Roberts explained:  “Here at UHNS we actively look for infection, particularly MRSA or C difficile.  Once a patient has been in theatre, we use an antibiotic soaked small piece of protein in the wound.  This makes the wound area a hostile environment for infection bugs to develop, thus significantly reducing the risk of infection for the patient.  National infection rates for fractured neck of femur patients currently stand at over 4% and here in North Staffs our rate has been 1.4% for the past 2 years”.

The work being done by our team is now amongst the leading Trusts in the UK, and our good practice is being replicated elsewhere.  The work of the Trust has been recognised by the Journal of Hospital Infection and Health Service Journals as well as the UK and European Hip Societies.

Mr Roberts concluded:  “We have proved that with a dedicated team, a proactive approach to managing these patients and innovative thinking elderly, fragile patients who have suffered a fracture of this kind can recover, go home to their original home or care setting and have a greater chance of survival. The team hope to continue to improve and are determined not to rest on our laurels. We are extremely proud of this service and are delighted that our commitment and focus is being recognised by the Trust Board”.