The Swedish Fracture Register
The Swedish Fracture Register (SFR) was developed in 2009-2010. Registrations was started in 2011 in one department. Since 2012 more departments was invited to join. Implementation and development of the infrastructure in the SFR has since then evolved side by side. In SFR orthopaedic surgeons, residents or A&E doctors are registering data on the fracture such as patient characteristics, injury type and mechanism, open or closed fracture, relationship to implant or joint replacements, pathologic fracture, atypical fracture etc. One or more fracture can be registered at the same occasion and they are classified with the help of text explanations, pictograms and x-ray examples mainly by the AO/OTA classification. Both surgical and non-surgical treatments are registered and also subsequent treatments such as planned treatments or non-planned treatments as reoperations. The latter are considered failures and followed as the main outcome variable together with Patient Reported Outcome Measures (PROM) and mortality. Due to a real time connection to the tax agency data on mortality are updated each day. The registration process can be explored with the use of the Demo-site in the meny to the right.
The registration is webbased and a single registration takes 2-3 minutes to perform. Registrations are made in the acute setting at the A&E department as well as after surgery has been performed. All data are linked to the personal identity number which is unique for each Swedish citizen. Fractures that occur later will be added to the same patient's previous data and later reoperations will be linked to the appropriate injury date and fracture. The patients can also be followed between different hospitals and countys in the country because the data is available for all registered users.
Patient Reported Outcome Measures (PROM)s are recorded using SMFA and EQ5D. Data is registered with recall technique with function the week before the fracture occured. Patients that respond will get another questionnaire after one year which makes comparisons possible between the one year result and pre injury status on a broad scale. Approximately 800 questionnaires are currently entered into the database by patients each week (2022). From 2019 all PROMs are electronically available only.
Data is available for all users as statistics on an aggregate level. The statistics are easily accessed through predefined modules where all variables can be used and results filtered accordingly. Results can be compared between all participating departments and against the average values in the country. In 2022 100% of all departments treating fractures in Sweden has started registration. For most departments completeness reaches 75-95% of the possible match against official health databases. In the database more than 710 000 fractures are registered (2022).
For more information please read the three papers on how the SFR was started (1) the publication on the implementation process (2) and details of the first ten years of development (3) References:
1. The Swedish fracture register: 103,000 fractures registered. BMC Musculoskelet Disord. 2015 Nov 6;16:338. https://doi.org/10.1186/s12891-015-0795-8. Wennergren D, Ekholm C, Sandelin A, Möller M.
2. .Implementation of the Swedish Fracture Register, Unfallchirurg, https://doi.org/10.1007/s00113-018-0538-z, Wennergren D, Möller M
3. The Swedish Fracture Register – ten years of experience and 600,000 fractures collected in a Nation Quality Register BMC Musculoskeletal Disorders (2022) 23:141 https://doi.org/10.1186/s12891-022-05062-w Michael Möller; Olof Wolf; Carl Bergdahl; Sebastian Mukka; Emilia Möller Rydberg; Nils P. Hailer; Jan Ekelund; David Wennergren
You can find a complete list of publications here.