A Cochrane review published in September 2022 found that both in hospital and after discharge, treatment targeting mobility will help people get safely back on their feet, moving and walking again after hip fracture surgery.

This Cochrane review found 40 studies from 17 countries that included 4059 people with hip fracture, most of whom were over 65 years old, with an average age of 80. They evaluated the treatment provided to help people move better, including standing up and walking.

Eighteen studies evaluated mobility strategies that started in the hospital within a week after hip fracture surgery which found that they moderately increase people's mobility four months after their fracture and probably increase walking speed to a small but meaningful degree.

Mobility treatment undertaken after discharge from hospital in homes, retirement villages and outpatient clinics, improve mobility, function, reduce falls and probably increase walking speed.

The types of treatment that appear effective are exercises in addition to standard physiotherapy. The exercises that were helpful target balance, walking and functional tasks. After discharge from hospital, extra strength or endurance training may also improve mobility.

These findings confirm the importance of ensuring mobility is a key component of care for all patients who sustain a hip fracture around the world” says Professor Cathie Sherrington, one of the reviewers.

Click here to read the review.

Click here to access the review podcast.

For many individuals a fragility fracture is the result of a fall which can lead to significant injury. In Ireland, a Major Trauma Audit is completed on patients admitted to hospital as a result of a trauma. The data from 2019-2020 is reported in the Major Trauma Report, which was released in September 2022.   

The report includes data on 8,764 patients who have suffered a major trauma accident over 2019 and 2020 from the majority of the 26 hospitals involved in the audit, with a focus on the early impact of the COVID-19 pandemic on trauma activity and care.   

Professor Deasy, a lead author of the report commented: “This report presents the first picture of how trauma activity, care and outcomes were effected during a very tumultuous time in the Health Service due to the COVID-19 pandemic. The significance of this data can help to inform future public health strategies and the reconfiguration of the Trauma System when such events like a pandemic or cyber-attack occur”.  

There were a number of key findings within the report that influence the care for patients who have sustained a fragility fracture including:   

-The mean age of major trauma patients increased from 58 years in 2019 to 61 years in 2020.
-The percentage of falls of less than 2 m increased from 58% in 2019 to 62% in 2020.
-The proportion of patients injured at home increased from 48% in 2019 to 56% in 2020.
-There was an increase in the proportion of major trauma patients who died from falls. The percentage of those who died from falls less than 2 m increased from 59% in 2019 to 64% in 2020, while the percentage of those who died from falls more than 2 m increased from 11% in 2019 to 16% in 2020. 

There were also recommendations in the use and access to trauma services including: 

-There was an approximately 10% reduction in the number of major trauma admissions during 2020, compared with 2019.
-Both 2019 and 2020 had a low-level pre-alert rate of 12% which is designed to prepare the team for the admission.
-The overall percentage of major trauma patients received by a trauma team remains extremely low, at 8% in 2019 and 9% in 2020.
-As patients get older they are less likely to be pre-alerted, met by a trauma team or received by a senior clinician. 

Louise Brent, Audit Manager MTA, added: “The increase of falls in the home over the course of the first three waves of the pandemic shows us that there is a real opportunity for the public to use this information to ensure their homes are as safe as possible. Using the data on falls in the home we have created tools including a very quick checklist that anyone can use to identify common causes and risks that may be present in the home, the majority of which are easily remedied”.  

You can download the report here.

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