Hip fractures are one of the most common reasons for older adults to be admitted to hospital — but the rest isn’t just about Orthopaedics. Behind every fracture lies frailty, delirium, dementia, nutrition, rehabilitation, and the need for coordinated multidisciplinary teamwork. In this episode, we use hip fracture care as a lens to explore the wider challenges of caring for older patients in hospital. From the early days of surgical defeatism to today’s orthogeriatric-led models and national audit, we ask: what can hip fracture care teach us about treating older adults more holistically? 

Links:

Professor Johansen's Youtube Channel: https://www.youtube.com/@antonyjohansen

NICE Guidelines: https://www.nice.org.uk/guidance/cg124

National Hip Fracture Database: https://www.nhfd.co.uk/

BOA-BGS Blue Book: https://www.bgs.org.uk/sites/default/files/content/attachment/2018-05-02/Blue%20Book%20on%20fragility%20fracture%20care.pdf

Studies:

Hip fractures in the elderly: a world-wide projection: Cooper C et al, Osteoporosis Int, 1992;2:285-289, doi: 10.1007/BF01623184.

The unsolved fracture - a protest against defeatism: Dickson JBJS 1953; 35-A: 805-821.

Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial: Li T et al, JAMA. 2022 Jan 4;327(1):50-58, doi: 10.1001/jama.2021.22647.

Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture: Bhandari M et al, N Engl J Med. 2019 Dec 5;381(23):2199-2208, doi: 10.1056/NEJMoa1906190.

Management of the fractured neck of femur in the elderly female: a joint approach: Clarke and Wainwright. Gerontology Clinics 1966; 8:321-6, https://doi.org/10.1159/000244969.

The geriatric orthopaedic unit: Devas and Irvine. Brit J Geriatr Practice 1969; 6:19-25, https://doi.org/10.1177/112070001002000214.

Effectiveness of geriatric rehabilitation after proximal femur fracture in the elderly: Kennie et al. BMJ 1988; 297:1083-6, doi: 10.1136/bmj.297.6656.1083.

 Prospective randomised study of an orthopaedic geriatric in-patient service: Gilchrist et al. BMJ 1988; 297:1116-1118, doi: 10.1136/bmj.297.6656.1116.

Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures: Cameron et al. Cochrane Database 2001, Issue 3, doi: 10.1002/14651858.CD000106.

Increased orthogeriatrician involvement in hip fracture care and its impact on mortality in England: Neuburger et al. Age and Ageing 2016, doi: 10.1093/ageing/afw201 

The Impact of a National Clinician-led Audit Initiative on Care and Mortality after Hip Fracture in England: Neuburger et al. Medical Care 2015;53:686–691