![]() ![]() demonstrated how a machine learning approach can support hospitals to dramatically cut time needed to process abnormal chest radiographs 23. In the UK it is estimated that more than 300,000 radiographs remain unreported for over 30 days 23. The increasing demand on radiology departments often means that they cannot report all acquired radiographs in a timely manner. The total number of imaging and radiological examinations has steadily increased, for example the number of radiographs performed annually has increased by 25% from 1996 to 2014 21, 22. orthopaedic surgeon or radiologist specialising in musculoskeletal disorders).Ī critical issue affecting the general use of diagnostic imaging is the mismatch between demand and resource. Hence governance bodies such as the National Institute for Health and Care Excellence (NICE) place great emphasis on the choice of operation and implant that should be offered for different hip fracture types, reflecting both the evidence-base and the potential cost of some implant types 13, such that NICE compliant surgery is one of the six key performance indicators for the provision of hip fracture care in the UK 7.ĭespite fracture classification so strongly determining surgical treatment and hence patient outcomes, there is currently no standardised process as to who determines this classification in the UK (e.g. Furthermore, the choice of intervention for a given fracture type predicts the risk of death following surgery 20. ![]() The choice of operation and implant has a strong influence on treatment costs for example sliding hip screws and intramedullary nails are two of the treatment options for trochanteric fractures but the cost of intramedullary devices is 3 to 4.5 times higher than for sliding hip screws 13. ![]() Interobserver agreement is slight to fair whether using the original or new AO classification systems 18 and fair to substantial for the NHFD classification system 19.įracture classification, according to these methods, aids surgeons in selecting the right surgical interventions to treat the fracture to restore mobility. There are recognised limitations with the current methods used for the classification of fractures 17. The AO system further defines subclasses: Grade A1/A2 and Grade A3 for trochanteric fractures accordingly to trochanteric area involvement and the presence of displacement for intracapsular fractures. Figure 1 illustrates the three main classes of hip fractures: intracapsular, trochanteric (extracapsular), and subtrochanteric (extracapsular). Hip fractures can be classified using the AO system 14, or by describing the fracture location and displacement with a modification of this system, as used by the UK Falls and Fragility Fracture Audit Programme (FFFAP) 15 in their National Hip Fracture Database (NHFD) clinical audit 16. Surgical treatment of hip fractures is strongly influenced by the fracture type 12, 13. When patients suffer a hip fracture, treatment aims are to restore function and relieve pain whilst minimising risk of morbidity and mortality, hence 98% of hip fractures are managed operatively in the UK 8. Thus, the development of strategies to improve hip fracture management and hence their impact on mortality and healthcare provision costs is a high priority 10, 11. twice the age-specific mortality rate of the general population 9, 10. Patients who sustain a hip fracture have a reported 30-day mortality of 6.9% in the UK in 2019 8, with 30% of patients dying over the course of the first year, i.e. Currently, across the world, an estimated 1.6 million hip fractures occur annually with substantial economic burden, approximately $6 billion per year in the US 6 and about £2 billion in the UK 7. In 2019, 67,671 hip fractures were reported to the UK National Hip Fracture Database 2 given the projections for population ageing over the coming decades, the number of hip fractures is predicted to increase globally, particularly in Asia 3, 4, 5. Hip fractures are a major cause of morbidity and mortality for the elderly, and incur high direct health costs 1. ![]()
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