Introduction: There will be more than ten thousand cases of fragility hip fracture (FHF) per year in Hong Kong projected in 2031. With the ageing population and the increasing incidence of osteoporosis, it is without doubt that FHF will have enormous impact on the population and the health care system. By comparing the outcomes of FHF patients admitted to public hospitals in Hong Kong to the international standard, we noticed that the FHF management in Hong Kong has not been systematic enough to keep up with the ever-increasing incidence of osteoporosis and FHF. A working group on Fragility Fracture Registry from different Hospitals in Hong Kong has been set up since the early 2013, with a clear objective of promoting the best multidisciplinary care for early operation, stable fixation or replacement, early weight bearing and mobilization, and appropriate bone health management to prevent secondary fragility fractures in Hong Kong.
Method: A unified pathway for holistic management of FHF, from admission, operation, rehabilitation, back to community and secondary fracture prevention, was established this year and is piloted in our center since June 2015. A detailed protocol concerning data collection, standardized clinical and surgical management, discharge planning and rehabilitation was designed. This pathway includes all patients with hip fracture resulting from fall on standing height and it involves orthopaedic surgeons, physicians, anaesthetists, nursing staff, physiotherapists, occupational therapists, speech therapists, dieticians, orthotics specialists, clinical psychologists and medical social workers, to provide a multidisciplinary holistic care to patients with FHF. The primary outcome measures include the time from admission to operation, length of stay, mortality and medical and surgical complications; the secondary outcome measures include re-admission rate and functional outcome. Demographic data, the Charlson Comorbidity index and the Functional Comorbidity Score are recorded. Dedicated day-time operative sessions for FHF have increased to cater the increasing needs. Bone health management is supported by physicians who would assess all patients with FHF in the Osteoporosis Clinic upon discharge from acute hospital.
Future integrated model of care: The FHF pathway and the bone health management on FHF patients are being the initial phase of modification of care for patients with fragility fracture in Hong Kong. With further support from the hospital executives and geriatricians in our centre, we are going to expand the holistic care by establishing Ortho-geriatric wards in 2016 in which patients with FHF or with fragility fractures involving other parts of the body, will be co-cared by orthopaedic surgeons and geriatricians during acute hospitalisation period. Modification on operative implants and technique, weekend rehabilitation, public screening and prevention of osteoporosis and public education of fall prevention are of equal importance and need to be emphasised.
Result: Short-term outcome measurements and results of adopting the unified pathway in our centre will be updated in the near future.
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