Skip to main content

Advertisement

SpringerLink
Log in

Geriatric hip fracture management: keys to providing a successful program

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Hip fractures are a common event in older adults and are associated with significant morbidity, mortality and costs. This review examines the necessary elements required to implement a successful geriatric fracture program and identifies some of the barriers faced when implementing a successful program.

Intervention

The Geriatric Fracture Center (GFC) is a treatment model that standardizes the approach to the geriatric fracture patient. It is based on five principles: surgical fracture management; early operative intervention; medical co-management with geriatricians; patient-centered, standard order sets to employ best practices; and early discharge planning with a focus on early functional rehabilitation. Implementing a geriatric fracture program begins with an assessment of the hospital’s data on hip fractures and standard care metrics such as length of stay, complications, time to surgery, readmission rates and costs. Business planning is essential along with the medical planning process.

Conclusion

To successfully develop and implement such a program, strong physician leadership is necessary to articulate both a short- and long-term plan for implementation. Good communication is essential—those organizing a geriatric fracture program must be able to implement standardized plans of care working with all members of the healthcare team and must also be able to foster relationships both within the hospital and with other institutions in the community. Finally, a program of continual quality improvement must be undertaken to ensure that performance outcomes are improving patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. NHDS (2015) National Hospital Discharge Survey, National Center for Health Statistics, “Health Data, Interactive, Health care Use and Expenditures”, Centers for Disease Control. http://www.cdc.gov/nchs/data/databriefs/db182.htm. Accessed 31 Jan 2016.

  2. National Center for Injury Prevention and Control CfDCaPCfDCaP (2015) Injury Prevention & Control: Data & Statistics (WISQARS). http://www.cdc.gov/injury/wisqars/. Accessed 15 Oct 2015.

  3. Brown CA, Starr AZ, Nunley JA. Analysis of past secular trends of hip fractures and predicted number in the future 2010–2050. J Orthop Trauma. 2012;26(2):117–22. doi:10.1097/BOT.0b013e318219c61a.

    Article  PubMed  Google Scholar 

  4. Mears S, Kates S, Ahmed O, Bass J, Tyler W, et al. A guide to improving the care of patients with fragility fractures, second edition. Geriatr Orthop Surg Rehabil. 2015;6(2):58–120.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kannus P, Parkkari J, Sievanen H, Heinonen A, Vuori I, Jarvinen M. Epidemiology of hip fractures. Bone. 1996;18(1 Suppl):57S–63S.

    Article  CAS  PubMed  Google Scholar 

  6. Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003;51(3):364–70 (pii: jgs51110).

    Article  PubMed  Google Scholar 

  7. Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clin Orthop Relat Res. 1990;252:163–6.

    PubMed  Google Scholar 

  8. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth. 2008;55(3):146–54. doi:10.1007/BF03016088.

    Article  PubMed  Google Scholar 

  9. Giusti A, Barone A, Razzano M, Pizzonia M, Pioli G. Optimal setting and care organization in the management of older adults with hip fracture. Eur J Phys Rehabil Med. 2011;47(2):281–96 (pii: R33112529).

    CAS  PubMed  Google Scholar 

  10. Balasubramanian A, Tosi LL, Lane JM, Dirschl DR, Ho PR, O’Malley CD. Declining rates of osteoporosis management following fragility fractures in the U.S., 2000 through 2009. J Bone Jt Surg Am. 2014;96(7):e52. doi:10.2106/JBJS.L.01781.

    Article  Google Scholar 

  11. Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med. 2009;169(18):1712–7. doi:10.1001/archinternmed.2009.321.

    Article  PubMed  Google Scholar 

  12. Friedman SM, Mendelson DA, Kates SL, McCann RM. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc. 2008;56(7):1349–56. doi:10.1111/j.1532-5415.2008.01770.x.

    Article  PubMed  Google Scholar 

  13. Kates SL, Mendelson DA, Friedman SM. Co-managed care for fragility hip fractures (Rochester model). Osteoporos Int. 2010;21(Suppl 4):S621–5. doi:10.1007/s00198-010-1417-9.

    Article  CAS  PubMed  Google Scholar 

  14. Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, Lydersen S, Halsteinli V, Saltnes T, Lamb SE, Johnsen LG, Saltvedt I. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet. 2015;385(9978):1623–33. doi:10.1016/S0140-6736(14)62409-0.

    Article  PubMed  Google Scholar 

  15. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil. 2010;1(1):6–14. doi:10.1177/2151458510378105.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kates SL, Mendelson DA, Friedman SM. The value of an organized fracture program for the elderly: early results. J Orthop Trauma. 2011;25(4):233–7. doi:10.1097/BOT.0b013e3181e5e901.

    Article  PubMed  Google Scholar 

  17. Della Rocca GJ, Moylan KC, Crist BD, Volgas DA, Stannard JP, Mehr DR. Comanagement of geriatric patients with hip fractures: a retrospective, controlled, cohort study. Geriatr Orthop Surg Rehabil. 2013;4(1):10–5. doi:10.1177/2151458513495238.

    Article  PubMed  Google Scholar 

  18. Collinge CA, McWilliam-Ross K, Beltran MJ, Weaver T. Measures of clinical outcome before, during, and after implementation of a comprehensive geriatric hip fracture program: is there a learning curve? J Orthop Trauma. 2013;27(12):672–6. doi:10.1097/BOT.0b013e318291f0e5.

    Article  PubMed  Google Scholar 

  19. Gu Q, Koenig L, Mather RC 3rd, Tongue J. Surgery for hip fracture yields societal benefits that exceed the direct medical costs. Clin Orthop Relat Res. 2014;472(11):3536–46. doi:10.1007/s11999-014-3820-6.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Moja L, Piatti A, Pecoraro V, Ricci C, Virgili G, Salanti G, Germagnoli L, Liberati A, Banfi G. Timing matters in hip fracture surgery: patients operated within 48 h have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One. 2012;7(10):e46175. doi:10.1371/journal.pone.0046175.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609–16. doi:10.1503/cmaj.092220.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Liem IS, Kammerlander C, Suhm N, Kates SL, Blauth M. Literature review of outcome parameters used in studies of geriatric fracture centers. Arch Orthop Trauma Surg. 2014;134(2):181–7. doi:10.1007/s00402-012-1594-4.

    Article  CAS  PubMed  Google Scholar 

  23. Fisher AA, Davis MW, Rubenach SE, Sivakumaran S, Smith PN, Budge MM. Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare. J Orthop Trauma. 2006;20(3):172–8. doi:10.1097/01.bot.0000202220.88855.16 (discussion 179-180).

    Article  CAS  PubMed  Google Scholar 

  24. O’Malley NT, Blauth M, Suhm N, Kates SL. Hip fracture management, before and beyond surgery and medication: a synthesis of the evidence. Arch Orthop Trauma Surg. 2011;131(11):1519–27. doi:10.1007/s00402-011-1341-2.

    Article  PubMed  Google Scholar 

  25. Alagiakrishnan K, Wiens CA. An approach to drug induced delirium in the elderly. Postgrad Med J. 2004;80(945):388–93. doi:10.1136/pgmj.2003.017236.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Wilk A, Sajjan S, Modi A, Fan CP, Mavros P. Post-fracture pharmacotherapy for women with osteoporotic fracture: analysis of a managed care population in the USA. Osteoporos Int. 2014;25(12):2777–86. doi:10.1007/s00198-014-2827-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Kates SL, Kates OS, Mendelson DA. Advances in the medical management of osteoporosis. Injury. 2007;38(Suppl 3):S17–23. doi:10.1016/j.injury.2007.08.007.

    Article  PubMed  Google Scholar 

  28. Bukata SV, Kates SL, O’Keefe RJ. Short-term and long-term orthopaedic issues in patients with fragility fractures. Clin Orthop Relat Res. 2011;469(8):2225–36. doi:10.1007/s11999-011-1779-0.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kates SL. Lean business model and implementation of a geriatric fracture center. Clin Geriatr Med. 2014;30(2):191–205 (3/4/2014).

    Article  PubMed  Google Scholar 

  30. Kates SL, O’Malley N, Friedman SM, Mendelson DA. Barriers to implementation of an organized geriatric fracture program. Geriatr Orthop Surg Rehabil. 2012;3(1):8–16. doi:10.1177/2151458512436423.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kates SL, Behrend C, Mendelson DA, Cram P, Friedman SM. Hospital readmission after hip fracture. Arch Orthop Trauma Surg. 2015;135(3):329–37. doi:10.1007/s00402-014-2141-2.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, VCU Medical Center, 1200 E. Broad St., Richmond, VA, 23298, USA

    N. Basu, M. Natour, V. Mounasamy & S. L. Kates

Authors
  1. N. Basu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Natour
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. Mounasamy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. L. Kates
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. L. Kates.

Ethics declarations

Conflict of interest

Niladri Basu, M. Natour, Varatharaj Mounasamy and Stephen L. Kates declare that they have no conflict of interest.

Compliance with ethical guidelines

This article does not contain any studies with human or animal subjects performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Basu, N., Natour, M., Mounasamy, V. et al. Geriatric hip fracture management: keys to providing a successful program. Eur J Trauma Emerg Surg 42, 565–569 (2016). https://doi.org/10.1007/s00068-016-0685-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-016-0685-2

Keywords

Search

Navigation