CURRENT HIP FRACTURE MANAGEMENT IN CHINA Jing ng Zhang ang, Rebecca Ivers, Jagnoor Jagnoor, Silvia Li, Maoyi Tian, Mohit Bhandari and the INORMUS investigator team
BACKGROUND • A rapidly ageing population in China (200m, over 60y, in 2015) a • Estimated 1.6m people aged over 50 will have a hip fracture by 2020 b • Huge burden, including financial, medical resources • Limited evidence on hip fracture management a. Social Service and Development Statistical Report, China, 2015 b. Epidemiology, Costs and Burden of Osteoporosis in Asia, 2009 2
BACKGROUND • INternational ORthopaedic MUlticenter Study (INORMUS) in Fracture Care - Prospective Observational Study • Globally, 40,000 participants with traumatic fracture • Objective: the incidence of major complications (mortality, re- operation, and infection) within 30 days and associated factors • Baseline survey and 30-day follow up 3
METHODS Inclusion Criteria • Over 18 years old • Traumatic fracture or dislocation within past 3 months Exclusion Criteria • Fractures of the skull, face, and ribs • Unwilling to comply with our follow up schedule 4
METHODS • Extracted hip fracture data from China sites • 12 hospitals (11 tertiary, 1 secondary) 5
METHODS Included Data • Demographic information • Comorbidities • Mechanism of injury • The type of surgery • Timeline from injury to surgery 6
RESULTS WORLDWIDE CHINA CHINA ~40,000 All Hip recruited into Fracture Fracture INORMUS 9,208 2,014 7
RESULTS Characteristics of participants (N = 2014) Characteristics Value Age – over 60 years old 81% Female 62% Illiterate 17% Smoker 11% Insurance – Yes 88% Comorbidities Hypertension 40% Diabetes 18% Osteoporosis 28% One or above 73% Hip fracture due to falls 87% 8 Hip fracture at home 60%
RESULTS Characteristics of Hip Fracture Treatment • Operative – 88% - Reamed Intramedullary Nail – 27% - Arthroplasty – 29% 9
RESULTS Characteristics of Hip Fracture Management Time to admission Time to antibiotic admin Time to surgery from from injury from injury admission median 7h average153h average 115h Only 23.6% cases met the recommended UK standard of receiving surgery within 48 hours of admission. 10
DISCUSSION • We were only able to assess one out of six standards of best practice in hip fracture management (Blue Book) • Further analysis identify what factors lead to delays in time to admission, and time to surgery • Prospective observational study and qualitative interviews will be conducted in different level hospitals to explore more details and associated factors • Development of clinical pathways are essential to optimize hip fracture management in the future 11
ACKNOWLEDGEMENT Hospitals in China Harbin Medical University Second Hospital, Jilin University Second Hospital, Shenyang Orthopedics Hospital, Beijing Chaoyang Hospital, Beijing Anzhen Hospital, Langfang People’s Hospital, Langfang Aidebao Hospital, Hanzhong People’s Hospital, Shanghai No.10 Hospital, The Second Affiliated Hospital of Wenzhou Medical University, The First Affiliated Hospital of Xiamen University Funding source National Health of Medical Research Council, (NHMRC) Australia Canadian Institutes of Health Research 12
Thank you for your attention… 13
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