Geriatric hip fracture clinical pathway: the Hong Kong experience

Abstract

Geriatric hip fracture is one of the commonest fractures in orthopaedic trauma. There is a trend of further increase in its incidence in the coming decades. Besides the development of techniques and implants to overcome the difficulties in fixation of osteoporosis bone, the general management of the hip fracture is also very challenging in terms of the preparation of the generally poorer pre-morbid state and complicate social problems associated with this group of patients. In order to cope with the increasing demand, our hospital started a geriatric hip fracture clinical pathway in 2007. The aim of this pathway is to provide better care for this group of patients through multidisciplinary approach. From year 2007 to 2009, we had managed 964 hip fracture patients. After the implementation of the pathway, the pre-operative and the total length of stay in acute hospital were shortened by over 5 days. Other clinical outcomes including surgical site infection, 30 days mortality and also incidence of pressure sore improved when compared to the data before the pathway. The rate of surgical site infection was 0.98%, and the 30 days mortality was 1.67% in 2009. The active participation of physiotherapists, occupational therapists as well as medical social workers also helped to formulate the discharge plan as early as the patient is admitted. In conclusion, a well-planned and executed clinical pathway for hip fracture can improve the clinical outcomes of the geriatric hip fractures.

The Effect of Care Pathways for Hip Fractures: A Systematic Review

“…The methodology of protocol implementation by resident staff/interns or the presence or absence of a care coordinator was reported in three studies [35,39,48]. In Roberts et al [39] the care coordinator was responsible for staff training and implementation of the CP.…”

“…In Roberts et al [39] the care coordinator was responsible for staff training and implementation of the CP. In Tallis and Balla [35] and Lau et al [48] the care coordinator did the audit of the actual organization of care and the data collection.…”

Geriatric Fracture Center

“…To improve standardization of the comanaged treatment, geriatric issues were predefined in clinical pathways. [13][14][15][16][17] However, in this study, it was not possible to determine how much of the model's success is due to the standardization of care with the use of clinical pathways or due to the expertise of the geriatrician and the multidisciplinary team.…”

“…[15][16][17] As well as focusing on trauma surgery, these pathways describe age-related and geriatric aspects such as estimating the risk of developing delirium, 18,19 paying attention to comorbidity, scoring preoperative and postoperative mobility, nutritional status upon admission, prevention of falls, and osteoporosis care. Using a fast-track procedure at the ED, the aim is to have the patient admitted to the GFC nursing ward within 1 hour of arrival.…”

Intraoperative failures of the PFNa II spiral blade

“…Early reduction and internal fixation is recommended as it allows patients for early mobilization and rapid pain relief in order to prevent complications from prolonged immobilization like pressure sore, deep vein thrombosis and pulmonary embolism [5][6]. It also helps to improve the hospital length of stay in both acute and convalescence hospital [7]. Cephalomedullary device is commonly used for treating the unstable trochanteric fracture (AO fracture classification 31-A2 and 31-A3) nowadays and it could be performed in a minimally invasive and timely manner.…”