Paper short abstract:

Periprosthetic femoral fractures are traumatic injuries that complicate concepts of injury and repair. In this presentation, we explore the complexities around standardising care for a heterogeneous condition in complex patients, and the trade-offs involved in centralising or decentralising care.

Paper long abstract:

Surgery for periprosthetic femoral fractures (PPFF) is a developing sub-specialism within orthopaedic trauma care. PPFFs are major injuries which occur in people who have previously had a hip replacement or hip fracture surgery, and the bone around the prosthesis breaks. Their incidence has increased as joint replacements have become more common, and numbers will escalate further due to an ageing and increasingly frail population. Our study aims to understand the best care for patients with PPFF by exploring variations across services in England. In this enquiry, standardisation is implicitly taken as one of the key goals.

We suggest that ongoing efforts to transform PPFF services might be understood as an example of multiple frictions, which makes us question the normalisation of standardisation in healthcare service design and delivery. Firstly, PPFFs are complex injuries in complex patients; variabilities in care pathways, from injury to surgery to recovery, mean that PPFFs are heterogeneous. Consequently, variations between patients and complex care needs mean that PPFF care is highly personalised. Finally, patient outcomes are thought to be better at ‘high volume’ centres, thus driving the centralisation of surgical skills and multidisciplinary expertise. However, the concentration of patients with complex injuries and multimorbidity at expert centres may not serve PPFF patients well as it puts distance between them and their support networks, delays surgery and threatens to overwhelm the centres. In this presentation, we explore the implications of these frictions for the making – or unmaking – of PPFF care as a necessary sub-specialism.