The Australian Commission on Safety and Quality in Health Care has unveiled an updated national clinical care standard for hip fractures. This revised standard reduces the recommended maximum time for surgery to 36 hours, down from 48 hours, aligning with international guidelines and covering patients who may need to be transferred for surgery.

Each year, about 19,000 Australians, mostly over 65 years old, suffer hip fractures, often leading to life-altering consequences. Hip fractures increase the risk of death, with one in four patients not surviving a year post-injury. Many survivors lose their independence and quality of life.

The updated standard aims to address these issues by emphasizing the need for prompt surgery, reducing pain, and facilitating recovery. It recognizes the vulnerability of older patients and the importance of timely intervention. The financial burden on the healthcare system, approximately $600 million annually, also highlights the urgency of improving hip fracture care.

While progress has been made since the introduction of the Hip Fracture Clinical Care Standard in 2016, there is still significant variation in surgery wait times, with some hospitals performing well below the recommended 36-hour threshold. The updated standard is expected to serve as a catalyst for change, setting expectations for consistent, high-quality hip fracture care and encouraging tailored treatments for individual patients.

“The Hip Fracture Clinical Care Standard sets expectations for how every patient should be cared for, while allowing for treatment to be tailored to the individual,” said Professor Jacqueline Close, Co-Chair of the ANZHFR and Co-Chair of the expert advisory group for the standard. She believes that the updated standard will be a lever of change to improve the care for hip fracture patients in Australia and thus improve the patient’s lives.

At FFN, we are pleased to announce the launch of this new Clinical Standard in Australia. Read more about this announcement here:

Click the link to access the new clinical standard

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Evaluating a hip fracture patient’s performance in the early phase of recovery (2 months after a fracture) improves prediction of impaired 12-month walking ability.

Walking ability indicates the level of functional recovery and independent living in patients with a hip fracture. Almost half of the older hip fracture patients who were able to walk before the fracture event can’t walk a block without assistance 1 year post hip fracture.

This study undertaken in USA explored the association between the assessment of physical performance early in the recovery period of 162 hip fracture patients and their 12-month post-fracture mobility.

SPPB score and 3-meter gait speed, two easily and quickly observed measures of functional performance, can provide important information regarding the ability to walk 1 block, an indicator of functional ability, at 12 months after a hip fracture. According to the study, these measures ‘not only predict gradual decline but also gradual recovery’ after a hip fracture.

Furthermore, other predictive factors of greater risk of mobility limitation at 12-months after a hip fracture were age, ability to walk 1 block pre-fracture and ability to walk 10 feet at 2 months post-fracture.

Dr Jay Magaziner, one of the authors, stated: "There are a number of reliable and objective tools that can assess the patient's functional recovery. These can be used by different health care professionals and will provide information that can optimize planning for the recovery of long-term mobility."

Read the article here!

We are pleased to share the paper entitled "Standardization of global hip fracture audit could facilitate learning, improve quality, and guide evidence-based practice, an international study of hip fracture registries in 20 countries using the Fragility Fracture Network 2022 Minimum Common Dataset". The paper is about assessing compatibility of existing registries with the Fragility Fracture Network 2022 Minimum Common Dataset. It was published in The Bone and Joint Journal on 1 September 2023. 

We hope you enjoy the article and please share with colleagues who are interested in audits. We thank everyone within the Hip Fracture Audit Special Interest Group who was involved for their excellent work.

Click here to read the article!

Fracture Liaison Services (FLS), that provide assessment, treatment and follow up to fracture patients using a multidisciplinary approach, have been shown to improve the care for fragility fracture patients in Malaysia and should be consolidated and expanded to provide care to individuals throughout the country. 

Fragility fractures, often resulting from low-impact injuries, become increasingly common as we age. These fractures can double the risk of experiencing another fracture in one's lifetime, with the highest risk occurring within 18 months of the initial fracture. Unfortunately, many patients do not receive proper risk assessments and interventions to reduce this risk. This is where the Fracture Liaison Service (FLS) steps in to bridge the gap in treatment. 

In Malaysia, a scoping review by Lim et al delved into the role of FLS services in Malaysia. FLS services are multidisciplinary in nature, involving various departments such as orthopedics, osteoporosis expertise, bone densitometry, rehabilitation, falls services, and primary care. These services are coordinated to provide comprehensive care for patients, including assessment, treatment, and follow-up. The review explored the current state of FLS services in Malaysia, noting that while there are 12 FLS services primarily located in the Klang Valley (an urban sector of Malaysia), coverage remains limited, and many Malaysians lack access to these services. 

The study also discussed the organization and delivery of FLS services, including team composition and patient eligibility criteria. Furthermore, it highlighted the impact of FLS, with one public hospital reporting increased BMD assessments (by about 2 to 3 folds) and medication adherence. It also emphasized the consensus among local experts and national guidelines supporting the expansion of FLS services and the need for a multidisciplinary approach. For instance, the Fragility Fracture Network Malaysia was established to improve the care for people with fragility fractures by prioritizing secondary fragility fracture prevention and promoting the role of the FLS. 

The study called for the consolidation of existing FLS services and the development of new ones to address the secondary fracture prevention gap in Malaysia. It stresses the importance of public awareness, research, and advocacy by specialist societies to make FLS a part of national policy and improve fracture prevention efforts. And finally, as stated in the study, “FLS services will be the key to address the secondary fracture prevention gap in Malaysia.”

Read the article here!

Older adults living with Alzheimer’s disease or related dementias (ADRD) have higher incidence and worse outcomes after a hip fracture. Days Spent at Home before the hip fracture episode could be taken into consideration at surgical decision making and discharge planning.

This study undertaken in USA explored the association between days at home (DAH) before a hip fracture and post-fracture outcomes, including 1-year mortality, in 16576 community-dwelling older adults living with ADRD.

Days at Home were calculated based on the number of days that each patient was alive and not in hospitals, skilled nursing facilities, days in hospital observation or emergency department during the study period (6 months prior to and 12 months post hip fracture).

A fundamental result of this study was that pre-fracture DAH offered valuable prognostic information about post-fracture recovery of this vulnerable population, as patients in more unfavorable pre-fracture condition with a lower number of DAH had:

Furthermore, higher number of DAH was significantly associated with full post-fracture recovery. This finding is of major importance, according to the authors of this study, due to the fact that it helps ‘raise recovery expectations’ and ‘undercut common misconceptions contributing to underutilization of aggressive rehabilitation care’ in these patients.

DAH can be used as an objective measure to report preoperative health of older adults with ADRD and contribute at the optimal decision making either for surgery, discharge or post-discharge care.

Read the article here!

Assessing for fracture risk in older patients who have undergone total hip and knee arthroplasties can be successfully completed using FRAX.

Postoperative periprosthetic fractures (PPF) are severe complications of total hip or knee arthroplasties (THA/TKA) and are associated with an important burden for patients as well as high costs for the health care system.

A study conducted in Austria evaluated the value of FRAX to estimate the risk of postoperative periprosthetic fractures in 167 patients following total hip and knee arthroplasty. For all patients, the 10-year probability of a major osteoporotic fracture and an osteoporotic hip fracture was calculated using FRAX.

The results of the study showed that the majority of patients with a postoperative periprosthetic fracture had an increased risk (10-year probability) of major osteoporotic fracture and hip fracture according to FRAX. Despite this high risk though, less than 10% of the patients received adequate anti-osteoporotic treatment.

Moreover, a significant correlation was found between the 10-year probability of a major osteoporotic fracture and hip fracture and postoperative periprosthetic fractures in THA and TKA, indicating that FRAX might be a useful tool in calculating fracture risk in these patients. The risk of PPF was also higher in older patients and patients who had sustained a previous fracture.

The study highlights, among other findings, the serious undertreatment of patients with PPF in respect to osteoporosis, an issue of major importance that must be managed by a multidisciplinary team.

Read the study here!

Early surgery is essential following a hip fracture as it improves the outcomes for patients and it results in lower rates of mortality, length of hospital stay and postoperative complications, thereby reducing the burden on the healthcare system.

This study undertaken in China explored the association between the surgical timing and the prognoses in 701 elderly patients with hip fracture, dividing them in the early surgery group (surgery within 2 days of admission) and the delayed surgery group (surgery after 2 days of admission). The two groups were compared in terms of perioperative parameters, complications within 30 days after surgery, prognostic indicators and complications six months after surgery.

The results of the study showed that:

These results reflect the findings in other regions of the world and further confirm the growing body of literature that early surgery, within 48 hours, is recommended for patients after a hip fracture improving outcomes for patients and reducing the burden on the system.

Read the study here.

The burden of care to manage hip fracture patients is growing with the number set to double by 2050 and a gap in fracture prevention strategies in countries around the globe.

Hip fracture is an acknowledged major public health problem worldwide, with a high burden of morbidity and mortality. A recent international study examined the incidence of hip fractures, postfracture treatment, and all-cause mortality following hip fractures, based on demographics, geography, and year, from 2005 to 2018.

Among the most remarkable results of this study, are the following:

Another significant result of the study was that hip fracture incidence rates have declined in recent years in most countries and regions. However, as the global population ages, the burden of hip fractures will increase, with the number of hip fractures projected to double by 2050. This, in combination with the gap in post-hip fracture prevention, means that we need to intensify the effort to optimise globally the multidisciplinary management of the patient with a fragility fracture, including secondary prevention, which is the cornerstone of FFN’s mission.

You can read the full study here!

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