Globally, there is important heterogeneity in nonoperative management of hip fractures, due to cultural, social, structural, and economic differences between healthcare systems. 

This is the first international survey of clinician perspectives on nonoperative hip fracture management. The authors explored the factors that influence clinicians’ decisions to undertake a nonoperative hip fracture management approach among older people and aimed to determine whether there is global heterogeneity regarding these factors between clinicians from high-income countries (HIC) and low- and middle-income countries (LMIC).

This cross-sectional study involved 406 respondents (physicians, nurses, allied health professionals) from 51 countries and used a 28-item questionnaire about estimated epidemiology, medical reasons, external influences, and clinical decision-making regarding nonoperative management of hip fractures. 

The results of the study indicated that:
• The estimated proportion of patients presenting to hospital with hip fracture, and the estimated proportion receiving surgical management, were lower among LMIC respondents than those from HIC.
• The most commonly selected reasons for choosing nonoperative hip fracture management among HIC and LMIC clinicians were acute comorbidity, chronic comorbidity, and patient choice. 
• LMIC clinicians were more likely to select insufficient resources, socioeconomic status of the patient, and the patient’s ability to pay as common reasons of nonoperative hip fracture management than HIC clinicians.

In general, global heterogeneity seems to exist between HIC and LMIC clinicians regarding factors such as anticipated life expectancy, insufficient resources, ability to pay, treatment costs, and perception of risk in hip fracture management decision-making. There seems to be some agreement among HIC and LMIC clinicians on factors such as the presence of acute and chronic comorbidities, type of hip fracture pattern, use of risk stratification tools, and patient thoughts and wishes.

Dr Lynn McNicoll, one of the authors, stated: ‘There is considerable debate on the comparative clinical outcomes for operative and nonoperative hip fracture management. Continued research is needed to inform the development of best practice guidelines to improve decision-making and the quality of hip fracture care among older people.' 

Click here to view the article!