CURRENT HIP FRACTURE MANAGEMENT IN CHINA Jing ng Zhang ang, - - PowerPoint PPT Presentation

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 2020b

• Huge burden, including financial, medical resources
• Limited evidence on hip fracture management

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• a. Social Service and Development Statistical Report, China, 2015
• b. Epidemiology, Costs and Burden of Osteoporosis in Asia, 2009

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-
• peration, and infection) within 30 days and associated factors
• Baseline survey and 30-day follow up

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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

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METHODS

• Extracted hip fracture data from China sites
• 12 hospitals (11 tertiary, 1 secondary)

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METHODS

Included Data

• Demographic information
• Comorbidities
• Mechanism of injury
• The type of surgery
• Timeline from injury to surgery

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RESULTS

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WORLDWIDE ~40,000 recruited into INORMUS CHINA All Fracture 9,208 CHINA Hip Fracture 2,014

RESULTS

Characteristics of participants (N = 2014)

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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% Hip fracture at home 60%

RESULTS

Characteristics of Hip Fracture Treatment

• Operative – 88%
• Reamed Intramedullary Nail – 27%
• Arthroplasty – 29%

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RESULTS

Characteristics of Hip Fracture Management

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Time to admission from injury

median 7h

Time to surgery from admission

average 115h

Time to antibiotic admin from injury

average153h

Only 23.6% cases

met the recommended UK standard of receiving surgery within 48 hours

• f admission.

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
• ptimize hip fracture management in the future

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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

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Thank you for your attention…