Shared responsibility across the multidisciplinary team is fundamental to delivery of hip fracture care.

This recent study, conducted in England, aimed to characterize professionals’ views about the core components of multidisciplinary teamwork in hip fracture care. Forty healthcare professionals including orthopaedic surgeons, orthogeriatricians, physiotherapists and service managers were interviewed.

Four core components of successful multidisciplinary teamwork for hip fracture care and one central underpinning concept were identified:

(1) defined roles and responsibilities,

(2) information transfer processes,

(3) shared goals and

(4) collaborative leadership.

In more detail:

• Defined roles and responsibilities were promoted through formal care pathways, reinforced through induction and training with clear job plans outlining tasks.
• Information transfer processes facilitated timely information exchange to appropriate individuals.
• Well-defined common purpose was hindered by complex interdisciplinary professional relationships, particularly between orthogeriatric and orthopaedic staff, and encouraged through multidisciplinary team meetings and training.
• Clinical service leads were integral to bridging interdisciplinary boundaries. Mutual trust and respect were based on recognition of the value of different professional groups.
• Teamwork depended on formal clinical leads with facilitative and motivational roles, and on hospital leadership that created an environment supporting collaboration.
• Shared responsibility for patients was encouraged by joint orthopaedic and orthogeriatric care models. Staff shared responsibility by assisting colleagues when needed.

According to the authors: "Our findings provide a basis for future training, skills development and assessment of multidisciplinary teamwork for hip fracture care in the UK. Further work is needed to understand leadership configurations in hip fracture care, particularly the role of ‘emergent’ leaders who do not have formal roles but exert considerable influence within teams."

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A survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association conducted in 2022 found considerable variation in care across the region.

The survey sought to document APOA members’ insights on aspects of care of fragility fracture patients (e.g. surgery, mobilisation, secondary fracture prevention). 521 APOA members completed the survey and notable findings included:

• 59% of respondents indicated that analgesia was routinely initiated in transit or within 30 minutes of arrival in the Emergency Department.
• One-quarter of respondents stated that more than 80% of their patients underwent surgery within 48 hours of admission.
• One-third of respondents considered non-hip, non-vertebral fractures to merit assessment of future fracture risk.
• One-third of respondents reported the presence of an Orthogeriatric Service in their hospital, and less than a quarter reported the presence of a Fracture Liaison Service.

In light of the Global Call to Action on Fragility Fractures published in 2018, a Call to Action for all National Orthopaedic Associations affiliated with APOA was proposed to improve the care of fragility fracture patients across the region in terms of the following:

1. Improvement in acute multidisciplinary care
2. Ongoing post-acute care
3. Rapid secondary prevention
4. Knowledge dissemination and training
5. Research and collaboration
6. Policy advocacy

According to Dr. Joon-Kiong Lee, one of the authors,: ‘Orthogeriatric care, a multidisciplinary care model, should be built as the standard of care in all nations for all patients who sustain fragility fractures, to prevent subsequent fractures.’.

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People following hip fracture receive increasing levels of unpaid care following their trauma, to support their ability to undertake ADLs at home compared to pre-fracture requirements.

This study, undertaken in UK, included 246 hip fracture patients and aimed at determining who are the unpaid carers of these patients, with which activities unpaid carers support patients and if this situation changes over time. Data were derived from the English Longitudinal Study of Ageing (ELSA) cohort.

The results indicated that:

• Whilst unpaid care was largely delivered by a spouse or the person’s child at the time of fracture, over time, there was increased delivery of unpaid care from a wider caregiving network including siblings and friends.
• The patients frequently received unpaid care for PADLs such as washing, dressing and eating/food preparation. Whilst this need decreased over time, there was increased support received for more complex tasks such as managing money, administering medications and more physically demanding activities such as housework.
• Unpaid care activities increased after hip fracture. These findings flag the need to formal educational courses to empower carers to more effectively support those they care for, whilst reducing overarching burden and anxiety.

According to the authors of this study: ‘Given the level of support unpaid carers offer, and previously reported carer stress and burden, undertaking clinical trials to assess the effectiveness of carer–patient support interventions would be valuable’.

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