Advertisement

Development of the Italian fractures registry (RIFra): A call for action to improve quality and safety

Published:October 11, 2020DOI:https://doi.org/10.1016/j.injury.2020.10.052

      Highlights

      • The AO-Trauma Italy council has encouraged the development of a national fracture registry in Italy (RIFra).
      • Thirteen AO-Trauma Italy members, chairmen of Level-I orthopaedic and trauma centres, diffused throughout Italy, were involved in the RIFra project.
      • The RIFra form, developed between November 2019 and March 2020, consists of 5 main sections, namely: epidemiologic data, previous surgical procedure (if any), patient and fracture features, surgical procedure, surgical implant details.
      • This study constitutes the first step to start, the bureaucratic procedure leading to the final establishment of a national fracture registry in Italy.

      Abstract

      In recent years, there has been an increasing interest in the development of arthroplasty registries, therefore, in our country, the Italian Arthroplasty Registry (RIAP), was issued by the National Law No. 221/2012.
      In the last decade, however, some European countries -namely Sweden, Denmark, Norway, and Germany (in development)- have introduced another nationwide orthopaedic registry than arthroplasty registers: the fracture registry. The development of this new tool aims to improve quality and safety in fracture management, thus trying to provide a better postoperative quality of life in trauma patients.
      Based on these findings, the AO-Trauma Italy Council encouraged the development of a national fracture registry in Italy. The present study aims to (1) provide an overview of the fracture registries in Europe and (2) to develop, for the first time, a pilot Italian Fracture Registry (RIFra).
      Thirteen AO-Trauma Italy members, chairmen of Level-I orthopaedic and trauma centres, diffused throughout Italy, were involved in the RIFra project. The RIFra form, developed between November 2019 and March 2020, consists of 5 main sections, namely: epidemiologic data, previous surgical procedure (if any), patient and fracture features, surgical procedure, surgical implant details. This study constitutes the first step to start, in future years, the bureaucratic procedure leading to the final establishment of a RIAP-like fracture registry in Italy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Carr A.
        Will registries slow down or accelerate innovation?.
        EFORT Open Rev. 2019; 4: 416-422https://doi.org/10.1302/2058-5241.4.180065
        • Lübbeke A.
        • Carr A.J.
        • Hoffmeyer P.
        Registry stakeholders.
        EFORT Open Rev. 2019; 4: 330-336https://doi.org/10.1302/2058-5241.4.180077
        • Varnum C.
        • Pedersen A.B.
        • Gundtoft P.H.
        • Overgaard S.
        The what, when and how of orthopaedic registers: an introduction into register-based research.
        EFORT Open Rev. 2019; 4: 337-343https://doi.org/10.1302/2058-5241.4.180097
        • Robertsson O.
        • Knutson K.
        • Lewold S.
        • Lidgren L.
        The Swedish knee arthroplasty register 1975-1997: an update with special emphasis on 41,223 knees operated on in 1988-1997.
        Acta Orthop Scand. 2001; 72: 503-513https://doi.org/10.1080/000164701753532853
        • Delaunay C.
        Registries in orthopaedics.
        Orthop Traumatol Surg Res. 2015; 101: S69-S75https://doi.org/10.1016/j.otsr.2014.06.029
      1. Decreto del presidente del consiglio dei ministri 3 marzo 2017. Gazzetta Ufficiale 2017. https://www.gazzettaufficiale.it/eli/id/2017/05/12/17A03142/sg.

      2. LEGGE, 2012. 17 dicembre 2012 n. 221. Gazzetta Ufficiale. https://www.gazzettaufficiale.it/eli/id/2012/12/18/012G0244/sg.

        • Beirer M.
        • Kirchhoff C.
        • Biberthaler P.
        Development of a German fracture register to assess current fracture care and improve treatment quality: a feasibility study.
        EFORT Open Rev. 2017; 2: 474-477https://doi.org/10.1302/2058-5241.2.160086
        • Piazzolla A.
        • Solarino G.
        • Bizzoca D.
        • Parato C.
        • Monteleone G.
        • Dicuonzo F.
        • et al.
        The pedicle instrumentation and percutaneous elevation (Pi.Pe): a new cementless surgical technique in type A post-traumatic vertebral fractures.
        Eur Spine J. 2018; 27: 182-189https://doi.org/10.1007/s00586-018-5602-4
        • Piazzolla A.
        • Bizzoca D.
        • Solarino G.
        • Moretti L.
        • Moretti B.
        Vertebral fragility fractures: clinical and radiological results of augmentation and fixation—a systematic review of randomized controlled clinical trials.
        Age Clin Exp Res. 2019; https://doi.org/10.1007/s40520-019-01289-1
        • Kristensen T.B.
        • Furnes O.
        • Gjertsen J.E.
        • Dybvik E.
        • Engesæter L.B.
        More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures.
        Bone Jt J. 2018; (100B)https://doi.org/10.1302/0301-620X.100B12.BJJ-2018-0262.R1
        • Gjertsen J.E.
        • Engesaeter L.B.
        • Furnes O.
        • Havelin L.I.
        • Steindal K.
        • Vinje T.
        • et al.
        The Norwegian hip fracture register: experiences after the first 2 years and 15,576 reported operations.
        Acta Orthop. 2008; 79: 583-593https://doi.org/10.1080/17453670810016588
        • Pollmann C.T.
        • Røtterud J.H.
        • Gjertsen J.E.
        • Dahl F.A.
        • Lenvik O.
        • Årøen A.
        Fast track hip fracture care and mortality - an observational study of 2230 patients.
        BMC Musculoskelet Disord. 2019; 20https://doi.org/10.1186/s12891-019-2637-6
        • Wennergren D.
        • Möller M.
        Implementation of the Swedish fracture register.
        Unfallchirurg. 2018; 121: 949-955https://doi.org/10.1007/s00113-018-0538-z
        • Wolf O.
        • Sjöholm P.
        • Hailer N.P.
        • Möller M.
        • Mukka S.
        Study protocol: hipsther- a register-based randomised controlled trial-hip screws or (total) hip replacement for undisplaced femoral neck fractures in older patients.
        BMC Geriatr. 2020; 20https://doi.org/10.1186/s12877-020-1418-2
        • Mattisson L.
        • Bojan A.
        • Enocson A.
        Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register 11 medical and health sciences 1103 clinical sciences 11 medical and health sciences 1117 public health and health services.
        BMC Musculoskelet Disord. 2018; 19https://doi.org/10.1186/s12891-018-2276-3
        • Wennergren D.
        • Bergdahl C.
        • Ekelund J.
        • Juto H.
        • Sundfeldt M.
        • Möller M.
        Epidemiology and incidence of tibia fractures in the Swedish fracture register.
        Injury. 2018; 49: 2068-2074https://doi.org/10.1016/j.injury.2018.09.008
        • Morgonsköld D.
        • Warkander V.
        • Savvides P.
        • Wihlborg A.
        • Bouzereau M.
        • Möller H.
        • et al.
        Inter- and intra-rater reliability of vertebral fracture classifications in the Swedish fracture register.
        World J Orthop. 2019; 10: 14-22https://doi.org/10.5312/wjo.v10.i1.14
        • Knutsson S.B.
        • Wennergren D.
        • Bojan A.
        • Ekelund J.
        • Möller M.
        Femoral fracture classification in the Swedish fracture register - a validity study.
        BMC Musculoskelet Disord. 2019; 20https://doi.org/10.1186/s12891-019-2579-z
        • Rundgren J.
        • Bojan A.
        • Mellstrand Navarro C.
        • Enocson A.
        Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register.
        BMC Musculoskelet Disord. 2020; 21: 88https://doi.org/10.1186/s12891-020-3097-8
        • Gromov K.
        • Brix M.
        • Kallemose T.
        • Troelsen A.
        Early results and future challenges of the Danish fracture database.
        Dan Med J. 2014;
        • Friesgaard K.D.
        • Gromov K.
        • Knudsen L.F.
        • Brix M.
        • Troelsen A.
        • Nikolajsen L.
        Persistent pain is common 1 year after ankle and wrist fracture surgery: a register-based questionnaire study.
        Br J Anaesth. 2016; 116: 655-661https://doi.org/10.1093/bja/aew069
        • Nyholm A.M.
        • Palm H.
        • Sandholdt H.
        • Troelsen A.
        • Gromov K.
        • Danish Fracture Database Collaborators
        Osteosynthesis with parallel implants in the treatment of femoral neck fractures: minimal effect of implant position on risk of reoperation.
        J Bone Joint Surg Am. 2018; 100: 1682-1690https://doi.org/10.2106/JBJS.18.00270
        • Nyholm A.M.
        • Palm H.
        • Kallemose T.
        • Troelsen A.
        • Gromov K.
        • DFDB collaborators
        No association between surgical delay and mortality following distal femoral fractures. A study from the Danish fracture database collaborators.
        Injury. 2017; 48: 2833-2837https://doi.org/10.1016/j.injury.2017.10.022
        • Jon Andersen M.
        • Gromov K.
        • Brix M.
        • Troelsen A.
        • Jordy A.
        • Wallin Paulsen A.
        • et al.
        The Danish fracture database can monitor quality of fracture-related surgery, surgeons’ experience level and extent of supervision.
        Dan Med J. 2014; 61
        • Jansson V.
        • Grimberg A.
        • Melsheimer O.
        • Perka C.
        • Steinbrück A.
        Orthopaedic registries: the German experience.
        EFORT Open Rev. 2019; 4: 401-408https://doi.org/10.1302/2058-5241.4.180064
        • Carrozzo M.
        • Vicenti G.
        • Pesce V.
        • Solarino G.
        • Rifino F.
        • Spinarelli A.
        • et al.
        Beyond the pillars of the ankle: a prospective randomized CT analysis of syndesmosis’ injuries in Weber B and C type fractures.
        Injury. 2018; 49: S54-S60https://doi.org/10.1016/j.injury.2018.10.005
      3. http://www.alterstraumaregister-dgu.de/index.php?id=1367.

        • Piazzolla A.
        • Solarino G.
        • Bizzoca D.
        • Garofalo N.
        • Dicuonzo F.
        • Setti S.
        • et al.
        Capacitive coupling electric fields in the treatment of vertebral compression fractures.
        J Biol Regul Homeost Agents. 2015; 29
        • Solarino G.
        • Piazzolla A.
        • Mori C.M.
        • Moretti L.
        • Patella S.
        • Notarnicola A.
        Alumina-on-alumina total hip replacement for femoral neck fracture in healthy patients.
        BMC Musculoskelet Disord. 2011; 12: 32https://doi.org/10.1186/1471-2474-12-32
        • Mori C.M.
        • Vicenti G.
        • Carrozzo M.
        • Picca G.
        • Bizzoca D.
        • Leone A.
        • et al.
        The fake unlocked femoral nail: a configuration to avoid in stable pertrochanteric femur fractures.
        Injury. 2018; 49: S32-S36https://doi.org/10.1016/j.injury.2018.09.057
        • Caiaffa V.
        • Vicenti G.
        • Mori C.
        • Panella A.
        • Conserva V.
        • Corina G.
        • et al.
        Is distal locking with short intramedullary nails necessary in stable pertrochanteric fractures? A prospective, multicentre, randomised study.
        Injury. 2016; 47: S98-106https://doi.org/10.1016/j.injury.2016.07.038
        • Ciaffa V.
        • Vicenti G.
        • Mori C.M.
        • Panella A.
        • Conserva V.
        • Corina G.
        • et al.
        Unlocked versus dynamic and static distal locked femoral nails in stable and unstable intertrochanteric fractures. A prospective study.
        Injury. 2018; 49: S19-S25https://doi.org/10.1016/j.injury.2018.09.063
        • Vicenti G.
        • Bizzoca D.
        • Nappi V.S.
        • Carrozzo M.
        • Delmedico M.
        • Solarino G.
        • et al.
        The impact of lag screw in the healing time of distal tibia fractures treated with minimally invasive plate osteosynthesis: a randomized clinical trial.
        Injury. 2020; https://doi.org/10.1016/j.injury.2020.02.042
        • Vicenti G.
        • Solarino G.
        • Carrozzo M.
        • Bizzoca D.
        • Marinelli A.
        • Rotini R.
        • et al.
        Box-loop technique in the management of complex elbow instability: a prospective controlled trial.
        Muscles Ligaments Tendons J. 2018; 8https://doi.org/10.11138/mltj/2018.8.2.191
        • Rollo G.
        • Solarino G.
        • Vicenti G.
        • Picca G.
        • Carrozzo M.
        • Moretti B.
        Subtrochanteric femoral shortening osteotomy combined with cementless total hip replacement for Crowe type IV developmental dysplasia: a retrospective study.
        J Orthop Traumatol. 2017; 18: 407-413https://doi.org/10.1007/s10195-017-0466-7
        • Stella M.
        • Santolini E.
        • Felli L.
        • Santolini F.
        • Horwitz D.S.
        Semiextended tibial nail insertion using an extraarticular lateral parapatellar approach: a 24-month follow-up prospective cohort study.
        J Orthop Trauma. 2019; 33: e366-e371https://doi.org/10.1097/BOT.0000000000001554
        • Pantalone A.
        • Vanni D.
        • Guelfi M.
        • Belluati A.
        • Salini V.
        Double plating for bicolumnar distal humerus fractures in the elderly.
        Injury. 2017; 48: S20-S23https://doi.org/10.1016/S0020-1383(17)30652-6
        • Belluati A.
        • Pari C.
        • Busatto C.
        • Pantalone A.
        • Salini V.
        Intercalary allograft reconstruction in a patient with large tibial defect: case report.
        Injury. 2018; 49: S39-S42https://doi.org/10.1016/j.injury.2018.09.056
        • Vicenti G.
        • Carrozzo M.
        • Caiaffa V.
        • Abate A.
        • Solarino G.
        • Bizzoca D.
        • et al.
        The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study.
        Int Orthop. 2019; 43: 193-200https://doi.org/10.1007/s00264-018-4214-2
        • Vicenti G.
        • Bizzoca D.
        • Carrozzo M.
        • Nappi V.
        • Rifino F.
        • Solarino G.
        • et al.
        The ideal timing for nail dynamization in femoral shaft delayed union and non-union.
        Int Orthop. 2019; 43: 217-222https://doi.org/10.1007/s00264-018-4129-y
        • Santolini E.
        • West R.M.
        • Giannoudis P.V.
        Leeds-Genoa non-union index: a clinical tool for asessing the need for early intervention after long bone fracture fixation.
        Int Orthop. 2020; 44: 161-172https://doi.org/10.1007/s00264-019-04376-0
        • Stella M.
        • Santolini E.
        • Sanguineti F.
        • Felli L.
        • Vicenti G.
        • Bizzoca D.
        • et al.
        Aetiology of trauma-related acute compartment syndrome of the leg: a systematic review.
        Injury. 2019; 50: S57-S64https://doi.org/10.1016/j.injury.2019.01.047
        • Vicenti G.
        • Bizzoca D.
        • Nappi V.
        • Pesce V.
        • Solarino G.
        • Carrozzo M.
        • et al.
        Serum biomarkers in the diagnosis of periprosthetic joint infection: consolidated evidence and recent developments.
        Eur Rev Med Pharmacol Sci. 2019; 23: 43-50https://doi.org/10.26355/eurrev_201904_17473
        • Vicenti G.
        • Pesce V.
        • Bizzoca D.
        • Nappl V.
        • Palmiotto F.
        • Carrozzo M.
        • et al.
        Perioperative plasmatic presepsin levels in patients undergoing total hip or knee replacement: a preliminary study.
        J Biol Regul Homeost Agents. 2017; 31: 1081-1085
        • Fuchs T.
        • Stange R.
        • Schmidmaier G.
        • Raschke M.J.
        The use of gentamicin-coated nails in the tibia: preliminary results of a prospective study.
        Arch Orthop Trauma Surg. 2011; 131: 1419-1425https://doi.org/10.1007/s00402-011-1321-6
        • Demitri S.
        • Vicenti G.
        • Carrozzo M.
        • Bizzoca D.
        • De Franceschi D.
        • Moretti B.
        The Masquelet technique in the treatment of a non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss: a case report.
        Injury. 2018; 49: S58-S62https://doi.org/10.1016/j.injury.2018.11.039
        • Solarino G.
        • Abate A.
        • Vicenti G.
        • Spinarelli A.
        • Piazzolla A.
        • Moretti B.
        Reducing periprosthetic joint infection: what really counts?.
        Joints. 2016; 3https://doi.org/10.11138/JTS/2015.3.4.208
        • Colombelli A.
        • Belluati A.
        • Rizqallah Y.
        • Guerra G.
        • Busatto C.
        Patient specific instrumentation in total knee arthroplasty.
        Acta Biomed. 2017; 88: 45-47https://doi.org/10.23750/abm.v88i2-S.6511