Subsequent Treatment Following Proximal Femoral Fracture - Who, When, Where? Assessment of the Current Situation in Germany

Background: Geriatric fractures are an increasing challenge for the German health-care system. While the acute care for patients with proximal femoral fractures is already standardised, differences remain in the further treatment and rehabilitation. A survey was conducted in cooperation with the section of geriatric trauma (AG Alterstraumatologie) of the German Association of Trauma Surgery (DGU) to point out existing problems in this group of patients. Material and Methods: In October/November 2010 an electronic questionnaire, assessing the medical care for patients after proximal femoral fracture, was sent to 1080 medical directors of trauma and orthopaedic surgery departments in Germany. Results: 339 (31.4%) departments participated. The analysis revealed that 57% of the hospitals had cooperation agreements with aftercare hospitals. 37% of all hospitals had problems in finding a rehabilitation hospital. The initiation of a rehabilitation procedure is almost exclusively based on the doctors' decision. Influence of employees with other professions is marginal. Mobility and Barthel index before the release from the acute care hospital are major factors in the decision making. Conclusion: The questionnaire confirms that there are problems in the aftercare service of geriatric patients all around Germany. A further improvement of collaboration between acute and aftercare hospitals is required.