Hip fractures: The state of the art in 2017

Abstract

Hip fracture continues to be the most common serious injury in the elderly population, with the United Kingdom National Hip Fracture Database reporting over 64 000 such injuries in the last calendar year.1 The most recent annual registry report reflects and highlights the socioeconomic challenges faced by our, and all healthcare systems, globally. Patients are getting older, but also fitter. Carers of nonagenarians are often themselves in their 70s, and the state is left undertaking the lion’s share of the carer’s responsibility. These significant numbers of injured patients result in the use of 1.5 million bed days and a total care bill of over £1 billion. In the United Kingdom, this equates to a single injury requiring approximately 1% of the total NHS budget.1 Studies estimating future trends have predicted significant increases in annual hip fracture incidence in the context of an ever-ageing population,2-4 with suggested figures as high as 100 000 hip fractures annually in the United Kingdom by 2033, and associated inflation-adjusted costs of up to £5.6 billion in total care.2 This is set against a continuing programme of austerity and value in the majority of developed nations’ healthcare systems. In parallel with rising numbers of cases, there is rising complexity. Baker et al3 found a trend of increasingly complex medical comorbidities and social needs, and surmised that the hip fracture-related healthcare bill would rise disproportionately to incidence changes alone, resulting from the greater cost of treating these higher-demand patients. The last decade has seen the implementation of several NICE quality standards, rigorous audit and best practice tariffs, with the aim of better patient and cost-effective treatment pathways. This investment in care has had the effect of improving outcomes and reducing length of stay while simultaneously cutting total healthcare delivery costs. …