Fragility fractures occur with low-energy trauma in patients with weakened bone strength and are associated with reductions in quality of life, function, and independence. The risk of re-fracture after a fragility fracture is significantly elevated. Prevention of secondary fractures is imperative as the population ages, given the morbidity, mortality, and costs directly attributable to these fractures. Unfortunately, treatment rates remain low despite the availability of effective therapies to reduce the risk of secondary fracture. We assessed the rate of pharmacologic treatment after vertebral, femur, or pelvic fracture within our academic medical center. In addition, we investigated potential factors, such as race or endocrinology consultation, which might influence post-fracture treatment. Our sample included 814 females over age 65, who sustained a hip, pelvis, or vertebral fracture between January 2018 and December 2021. Within the sample, 29.7% received an anti-fracture prescription within 6months of fracture. Those with osteoporosis included on their electronic health record (EHR) problem list had a significantly higher percent probability (28.6, 95% confidence interval (CI), 22.9, 34.3) of anti-fracture therapy prescription compared to those without osteoporosis on their problem list. Furthermore, Black patients were less likely to have a diagnosis of osteoporosis listed (p < 0.0001) and had a 10.9 percentage point lower probability of receiving a prescription compared to White patients (CI, 1.9, 19.9). These results suggest that the majority of patients in our health care system did not receive effective pharmacotherapy for secondary fracture prevention. The study highlights the need for more effective interventions to reduce secondary fractures.

Functional and Radiological Outcome of Biplane Double-Supported Screw Fixation for Fracture Neck Femur in Young Adults to Preserve the Natural Head

Femoral neck fractures remain a significant challenge in orthopaedic surgery, particularly among elderly patients. This review synthesizes the current peer-reviewed literature on initial management strategies, with a particular emphasis on the use of skin traction. Skin traction, which involves the application of adhesive tape, a crepe bandage, and a calibrated pulley system with precise weights, is analysed in terms of its efficacy in clinical practice. The review discusses the benefits and drawbacks of skin traction, drawing on recent studies to assess its role in fracture management. The goal is to provide nuanced scientific insights into the ongoing discourse surrounding the management of femoral neck fractures.

BACKGROUND Hip fractures in geriatric patients carry high morbidity and mortality due to advanced age, frailty, and multiple comorbidities. Accurate preoperative risk assessment is therefore essential. The hemoglobin-albumin-lymphocyte-platelet (HALP) score and prognostic nutritional index (PNI) are emerging immunonutritional biomarkers reflecting inflammatory and nutritional status. This study aimed to evaluate and compare the prognostic value of preoperative HALP and PNI scores for predicting 6-month mortality and postoperative complications in elderly hip fracture patients. MATERIAL AND METHODS This retrospective cohort included 549 patients aged≥³65 years who underwent surgical repair of proximal femoral fractures between January 2021 and July 2024. Demographic characteristics, comorbidities, fracture type, and preoperative laboratory data were analyzed. HALP and PNI scores were calculated from admission blood tests. Independent predictors of 6-month all-cause mortality were identified using Cox regression, and receiver-operating characteristic (ROC) analysis determined optimal cut-off values. RESULTS The mean age was 78±9 years, and 51.9% were female. Six-month mortality was 16.4%. Non-survivors had significantly lower HALP and PNI scores (P<0.001). In multivariate Cox analysis, coronary artery disease (HR 2.57, 95% CI 1.66-4.00), postoperative complications (HR 3.97, 95% CI 2.57-6.15), and lower HALP levels (HR 3.11, 95% CI 1.19-8.13) were independently associated with mortality. Additionally, ROC analysis identified a HALP cut-off value of 0.176 for predicting mortality. CONCLUSIONS The HALP score showed modest prognostic value for 6-month mortality and can complement established clinical predictors. Its use in preoperative evaluation could help identify higher-risk patients, but its discriminatory ability should be interpreted with caution.

Association between additional non-weekday rehabilitation and discharge function after hip fracture, modified by age and admission function: a retrospective study.

Home-based exercise reduces fall risk in older adults with mild cognitive impairment who have sustained a hip fracture: A 6-month randomized controlled trial.

To assess the comparative risk of osteoporosis and fractures associated with biological disease-modifying anti-rheumatic drug (bDMARD) exposure in patients with ankylosing spondylitis (AS). This nationwide cohort study analyzed 37,708 patients with AS. The outcomes of interest were osteoporosis, vertebral fracture, and hip fracture, defined based on diagnosis codes. The follow-up period was from the AS diagnosis date to December 2021. Multivariable time-varying Cox regression models were used to assess the comparative risk of each outcome comparing tumor necrosis factor inhibitors (TNFi) vs. bDMARD-naïve; interleukin-17 inhibitors (IL-17i) vs. bDMARD-naïve; and IL-17i vs. TNFi. For comparing IL-17i vs. TNFi, we matched the line of bDMARD treatment between the TNFi and IL-17i groups in a 4:1 ratio. The TNFi (adjusted hazard ratio [aHR]=0.83, 95% confidence interval [CI]=0.76-0.90, p<0.01) and IL-17i (aHR=0.19, 95% CI=0.10-0.38, p<0.01) exposures were associated with lower osteoporosis risk compared with the bDMARD-naïve group. Further, IL-17i (aHR=0.23, 95% CI=0.11-0.46, p<0.01) was associated with lower osteoporosis risk than TNFi. The TNFi (aHR=0.64, 95% CI=0.59-0.70, p<0.01) exposure was associated with lower vertebral fracture risk than the bDMARD-naïve group. IL-17i (vs. bDMARD-naïve) was associated with lower vertebral fracture risk, although this did not reach statistical significance (aHR=0.52, 95% CI=0.25-1.09, p=0.09). Hip fracture risk did not differ across different groups. TNFi and IL-17i exposures may be associated with a lower risk of osteoporosis, but not hip fractures, compared with bDMARD-naïve. TNFi exposure, but not IL-17i exposure, may be associated with a lower risk of vertebral fracture compared with bDMARD-naïve.

Biomechanical analysis of proximal femoral nail augmented with various screw configurations for proximal femoral fractures.

Internal fixation of undisplaced intracapsular hip fractures is typically achieved using either cannulated screws (CS) or a 2-hole dynamic hip screw (DHS). However, there is a lack of consensus on which of these is more effective clinically. Whilst several biomechanical analyses of cadaveric hips show a higher construct stability of DHS fixation, there is a paucity of large clinical studies investigating patient outcomes. Data from 2,705 patients at a single institution, including 322 internal fixations, were analysed retrospectively. Propensity scores were calculated to mitigate for the impact of covariates such as age, sex, Charlson comorbidity index and Nottingham Hip Fracture Score, producing an eligible group of 255 patients. The CS group included 204 patients (mean age, 82.5±7.5 years; female, 90.7%), the DHS group included 51 patients (mean age, 82.4±8.0 years; female, 90.2%). There were no differences between groups after propensity matching. There were no significant differences in outcomes between CS and DHS groups for reoperation rate (CS 5.9% vs. DHS 5.9%, P>0.999), death <30 days (CS 5.9% vs. DHS 5.9%, P>0.999), length of stay (CS 11.5 days vs. DHS 14.0 days, P=0.294) and hours to surgery (CS 31:03 hours vs. DHS 29:23 hours, P=0.618). However, operation time was significantly shorter for CS (CS 39.0 minutes vs. DHS 44.0 minutes, P=0.013), an 11% reduction. There is no difference in clinical outcomes between CS and DHS fixation of intracapsular hip fractures. However, in this cohort the operating time was approximately 5 minutes shorter in CS fixation.

Genetic contributors to osteoporosis in pregnancy and lactation associated osteoporosis (PLO).

Femoral neck system vs conventional fixation: Long-term outcomes from a single-center study.

The Femoral Neck System (FNS) is a fixed-angle side plate device approved for use in fixation of femoral neck fractures. The FNS perforates the lateral cortex of the subtrochanteric femur, which may increase the risk of postoperative subtrochanteric fractures compared with the inverted triangle cannulated screw (CS) construct. The purpose of this biomechanical study was to compare forces required to create subtrochanteric fractures in FNS and CS constructs in a synthetic bone biomechanical model. Osteopenic sawbones were divided into five groups: Noninstrumented femurs, CS with the inferior screw proximal to the midpoint of the lesser trochanter ("normal position," CSN), CS with the inferior screw distal to the lesser trochanter ("low position," CSL), one-hole FNS, and two-hole FNS. Models were loaded to failure on a Servohydraulic Test System. Means and standard deviations were calculated for load to failure. Each group was paired and analyzed using two-sample t-tests. Constructs in order of greatest to lowest load to failure include the following: Control (2950 N), one-hole FNS (2542 N), two-hole FNS (2444 N), CSN (2318 N), and CSL (2102 N). Load to failure was greater for the CSN group compared with CSL ( P = 0.04). Load to failure was greater for one-hole FNS versus CSL ( P = 0.002) and CSN ( P = 0.05). Load to failure was greater for two-hole FNS versus CSL ( P = 0.006) but not versus CSN ( P = 0.16). Load to failure was similar between one- and two-hole FNS ( P = 0.24). The FNS demonstrated failure at the subtrochanteric femur in this synthetic femora biomechanical model. The load to failure of FNS was superior compared with CS placed below the level of the lesser trochanter. The load to failure of the one-hole FNS was also superior to CS placed proximal to the midpoint of the lesser trochanter.

Fracture risk and treatment thresholds in patients with diabetes.

Impact of surgical timing on perioperative outcomes after open reduction and internal fixation of periprosthetic proximal femoral fractures.

Introduction: Falls and subsequent fractures represent a major public health concern among older adults. While fall prevention interventions have demonstrated efficacy in reducing falls, their impact on fracture outcomes remains unclear. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched multiple databases up to 7 June 2025 for studies investigating fall prevention interventions and fracture outcomes in community-dwelling older adults. A primary outcome was hip fractures; secondary outcomes included any fractures, falls, and serious fall injuries. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, using random-effects meta-analysis where appropriate. Results: Seventeen studies were included, spanning over 25,000 participants. Interventions included exercise programs, multifactorial approaches, medication optimization, and vitamin D supplementation. For hip fractures, only two randomized controlled trials (RCTs) reported extractable outcome data (12,489 participants; 132 events); both showed non-significant reductions favoring intervention (RR 0.80–0.87), precluding pooled meta-analysis. For any fractures, five studies (18,519 participants; 1343 events) demonstrated no significant effect (RR 0.91, 95% CI 0.72–1.14; p-value = 0.40) with significant heterogeneity (I2 = 65%). Fall prevention interventions significantly reduced falls across 14 studies. GRADE assessment indicated very low certainty for both hip fractures and any fractures due to limited studies, inconsistency, and imprecision. Conclusions: Current evidence suggests fall prevention interventions may reduce hip fractures but do not significantly prevent fractures overall. Despite consistent fall reduction, the translation to fracture prevention remains uncertain, highlighting the need for integrated interventions targeting both fall risk and bone health.

With population aging, hip fractures in elderly patients are a major medical problem. The impact of intraoperative hypotension (IOH) on adverse postoperative outcomes such as complications and mortality remains controversial. This study aimed to clarify this relationship for clinical guidance. A retrospective analysis was performed on patients over 65 years of age who had hip fracture surgery from July 2019 to Dec 2023. Patients were divided into IOH and No IOH groups. Propensity score matching (PSM) was used to reduce confounding factors. The primary outcome measures included postoperative complications (were grouped as one to two complications and three or more complications) and postoperative mortality. The secondary outcome measures included specific complications and length of hospital stay (LOS). After PSM, 546 patients were included. The IOH group had a higher proportion of patients with three or more postoperative complications (3.0% vs 0%). The total duration of IOH was an independent risk factor for both three or more postoperative complications and postoperative cardiovascular events. Postoperative delirium (POD) was associated with the total duration of IOH at a lower threshold (MAP ≤ 55 mmHg); mortality and acute kidney injury (AKI) incidence showed no significant differences between groups. Our results provide evidence of the associations between IOH and its detailed exposure metrics with adverse postoperative outcomes in elderly patients with hip fractures, and reveal that POD is associated with the total duration of IOH at a lower threshold (MAP ≤ 55 mmHg) in this population.

To determine if implementation of the HIP ATTACK protocol for hip fracture patients decreased delays in surgical fixation or post-operative mobilization. The primary hypothesis was that implementation of the HIP ATTACK protocols would improve time to surgery and time to mobilization. Design: This was a retrospective review of patients who underwent hip fracture surgery between January 2011 and January 2021. A single academic institution where HIP ATTACK protocols were implemented in September 2016. Patients >50 undergoing surgery for treatment of hip fractures (AO 31A1.2-3, 31A2-3, 31B1-3, 32A-C). Time of diagnosis defined as the time of the initial presenting radiograph and time of mobilization defined as the time the patient stood at edge of bed with physical therapy (PT) were determined. Average values before and after implementation of the HIP ATTACK protocol were compared using a student t-test with a p=0.05 set as the level of significance for each. A total of 781 patients were included in the analysis. There were 395 patients who had surgery prior to September 2016 (average age 79 years (range 50-102 years), 267 females and 187 males), and 386 patients who were operated on after HIP ATTACK implementation (average age 77 years (range 50-102 years), 232 females and 95 males). Compared to prior years, implementation of HIP ATTACK was associated with decreased time from diagnosis to surgery by an average of eight hours (30 vs 22 hours, p<0.0001) and decreased time from surgery to PT evaluation by an average of three hours (30 vs 27 hours, p=0.049). Time from surgery to mobilization was not significantly different before and after HIP ATTACK implementation (59 vs 58 hours, p=0.63). Implementation of the standardized HIP ATTACK protocol by a multidisciplinary team was associated with improvement in time to surgery and PT evaluation. A standardized, multidisciplinary protocol can minimize delay in caring for patients with hip fractures and is critical in limiting morbidity and mortality. 2.

Background/Objectives: Proximal femoral fractures (PFF) are associated with substantial morbidity and mortality in elderly patients. Early identification of individuals at increased risk of death remains challenging. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and readily available biomarker reflecting systemic inflammation and physiological stress, but its role as a risk stratification tool in surgically treated PFF patients is not fully established. The aim of this study was to validate NLR as a prognostic biomarker for mortality risk stratification in elderly hip fracture patients by evaluating its independent association with mortality, establishing clinically relevant risk categories, and assessing its ability to identify distinct mortality risk groups. Methods: This retrospective cohort study included 1113 patients aged ≥ 65 years who underwent surgery for AO/OTA 31.A (trochanteric) or 31.B (femoral neck) proximal femoral fractures between January 2021 and February 2024 at a single institution. NLR was calculated from routine admission bloodwork. The primary outcome was all-cause mortality. Kaplan–Meier survival analysis stratified patients by clinically relevant NLR categories (&lt;5, 5–10, &gt;10). Cox proportional hazards regression identified independent predictors of mortality. ROC analysis was performed secondarily to identify an optimal binary threshold. Results: At mean follow-up of 33.9 months, overall mortality was 36.2% (352/972). Stratified survival analysis demonstrated a clear dose–response relationship, with mortality rates of 26.2%, 36.5%, and 54.4% for NLR &lt; 5, 5–10, and &gt;10, respectively (log-rank p &lt; 0.001). In multivariable Cox regression, NLR remained independently associated with mortality (HR = 1.042, 95% CI: 1.032–1.053, p &lt; 0.001) after adjusting for age and time to surgery. ROC analysis identified an optimal binary cut-off of 6.59 (AUC 0.614). Conclusions: Elevated preoperative NLR is independently associated with increased mortality following surgery for proximal femoral fractures, particularly in very elderly patients. Given its simplicity and universal availability, NLR may represent a useful adjunct for early perioperative risk stratification.

Postmenopausal women experience ongoing loss of bone mass, with resulting increases in the risk of fracture. This review describes the nature of postmenopausal bone loss, the definition of osteoporosis, and the current status of fracture risk estimation, which is pivotal in osteoporosis management. Important lifestyle measures include taking a balanced diet to maintain a healthy weight throughout life, safe physical activity, not smoking, and moderating alcohol intake. Severe vitamin D deficiency accelerates bone loss so should be avoided. Falls prevention becomes increasingly important with age, since falls cause most fractures. Pharmaceuticals to increase bone mass and prevent fractures either act by inhibiting bone resorption or by stimulating bone formation. Bisphosphonates are the most widely used anti-resorptives, often taken as weekly oral doses. The intravenous bisphosphonate, zoledronate, has a long duration of action with effects on bone turnover, density and fractures over a decade after a single dose. It is increasingly used in both prevention and treatment of osteoporosis. Denosumab is effective in preventing fractures but has a rapid offset of effect after its cessation. Some anabolic agents act via the PTH1 receptor, producing substantial increases in spine bone density but are not yet proven to prevent hip fractures. Romosozumab is a monoclonal antibody directed at sclerostin. It has both anabolic and anti-resorptive effects, and shows broad anti-fracture efficacy. Anabolics are used for 1-2 years in those with high fracture risk, before transition to long-term anti-resorptive therapy. Treatment sequence options are discussed but more research is needed to establish which provide optimal fracture reduction.

Delirium is a common perioperative complication among older adults undergoing surgery for hip fractures. It is associated with increased risks of recurrent fractures, prosthesis-related complications, such as loosening, breakage, or dislocation, and overall delayed recovery. The etiology of delirium is multifactorial, involving intrinsic and precipitating factors spanning physiological, psychological, and environmental domains. Quality control circle (QCC) activities, defined as collaborative, problem-solving initiatives led by teams with shared or complementary responsibilities, are designed to promote continuous improvements in healthcare quality. The aim of this pilot study is to evaluate the effectiveness of QCC-based interventions in reducing the incidence of perioperative delirium among older adults with hip fractures. A double-blinded pilot study was conducted involving 90 older adults diagnosed with hip fractures between April 2022 and September 2023. Participants were assigned to either a control group (n = 46), receiving standard delirium management, or an intervention group (n = 44), which received additional QCC-based care strategies. Interventions included early mobilization, optimization of sleep duration and quality, cognitive and orientation support, and targeted delirium education for both patients and caregivers. Outcomes compared between groups included the incidence and duration of perioperative delirium, night-time sleep duration, and sleep quality index. The incidence of perioperative delirium was lower in the intervention group (9.0%) compared to the control group (17.4%). The duration of delirium episodes was significantly shorter in the intervention group (p < 0.001). In addition, the intervention group demonstrated significantly longer nocturnal sleep durations (p < 0.001) and higher sleep quality index scores (p < 0.001) compared to the control group. The integration of QCC-based interventions was associated with a reduced incidence and duration of perioperative delirium in older adults with hip fractures. Improvements in sleep quality and night-time sleep duration were observed, indicating that QCC activities may contribute to enhanced postoperative recovery in this population. However, these findings should be interpreted with caution given the relatively small sample size and single-center design.