The Swedish Fracture Register – ten years of experience and 600,000 fractures collected in a National Quality Register

Abstract

Background Before the creation of the Swedish Fracture Register (SFR), there was no national quality register that prospectively collects data regarding all types of fractures regardless of treatment in an emergency setting. Observational data on fractures registered in a sustainable way may provide invaluable tools for quality improvements in health care and research. Description Ten years after its implementation, the Swedish Fracture Register has 100% coverage among orthopaedic and trauma departments in Sweden. The completeness of registrations reached in 2020 69–96% for hip fractures at the different departments, with the majority reporting a completeness above 85%. The Swedish Fracture Register is a fully web-based national quality register created and run by orthopaedic professionals, with financial support from public healthcare providers and the government. All users have full access to both the registration platform and all aggregated statistics in real time. The web-based platform was created for use in health quality registers and it has easily gained acceptance among users. The register has gradually developed by the addition of more fracture types and skeletal parts. Research activity is high and 31 scientific publications have been published since 2016. The strategy from the start was to publish validation data and basic epidemiological data. However, over the past few years, publications on outcomes, such as re-operations and mortality, have been published and four register-based, randomised, controlled trials are ongoing. Conclusion It is possible to create a fracture register, to gain professional acceptance and to collect fracture data in a sustainable way on a national level if the platform is easy to use. Such a platform can also be used as a randomisation platform for prospective studies.

Lower mortality in distal femoral fractures in the presence of a knee arthroplasty: an observational study on 2,725 fractures from the Swedish Fracture Register

“…The register started in Gothenburg, Sweden in 2011. It was introduced stepwise in Sweden and by January 2021 all 54 orthopedic departments in Sweden participated (11). Orthopedic surgeons register data prospectively on basic patient characteristics, data on injury mechanism, fracture classification, and treatment.…”

“…The pDFF and DFF group were similar with regards to age, sex, and trauma mechanism. Unadjusted 90-day and 1-year mortality was 11% (95% CI [10][11][12] and 21% (CI [19][20][21][22][23], respectively. Kaplan-Meier survival analysis demonstrated a slightly lower mortality for pDFFs, especially in patients ≤ 70 years.…”

Study protocol: The DAICY trial—dual versus single-antibiotic impregnated cement in primary hemiarthroplasty for femoral neck fracture—a register-based cluster-randomized crossover-controlled trial

“…External validity guarantees that the findings are generalizable and can be applied to other contexts and groups outside the study design. The SFR, supplying the main register platform used for the inclusion of patients, is a population-based register ( 27 , 28 ), and the linkage of the study cohort with the SAR, NPR, and SPDR is being performed to access additional procedural details and baseline data outcomes. The high coverage and completeness of the SAR and NPR provide valid and reliable outcomes, and specificity is secured with the confirmation of PJI in the medical charts ( 12 , 19 ).…”

Age, sex, primary tumor type and site are associated with mortality after pathological fractures: An observational study of 1,453 patients from the Swedish Fracture Register

“…Using data from a national health care quality register with registration and classi cation of fractures entered by the treating physician enables the description of demographics, location, treatment choice and analysis of mortality. However, given the stepwise introduction and the present completeness of the SFR, we cannot identify the overall incidence, which could affect the external validity of the results [10]. The main limitations are linked to the retrospective study design and inherited limitations of register-based studies, including miscoding, transferring errors, under-reporting and missing data.…”

“…Guiding clinical decision-making algorithms (e.g., PATHFx) provide valuable aid in predicting patient outcome [9]. However, extensive register-based studies describing the treatment and outcome after pathological fractures in all body parts are scarce [10]. The Swedish Fracture Register (SFR) offers unique opportunities to conduct large register-based studies on pathological fractures in all body parts, regardless of treatment.…”