Recommendations on hip fractures

Hip fractures among the elderly are one of the major fragility fractures in terms of quality of life, health outcomes and medical costs [1]. Since mortality and morbidity are high, hip fractures have a direct impact on public health [2] and are one of the main reasons for disability [3]. Increases in age-adjusted incidence of falls with accompanying deterioration in age-adjusted bone quality may explain the reason for osteoporotic hip fractures among the elderly [2]. According to United Nations records from 2009, the average lifetime of human beings was 56 years in 1970; by 2000 it rose to 65 and by the year 2050 it is expected to be 75.5 years (73.3 for men and 77.9 for women) [4]. According to some epidemiological studies, there were 1.66 million hip fractures worldwide in 1990. Epidemiological projections estimate these annual figures to rise to 6.25 million by 2050 [2]. In another epidemiological study, the total number of hip fractures in 1990 was found to be 1.26 million; this is estimated to approximately double to 2.6 million by 2025 and to 4.5 million by 2050 [5]. As advances in medicine and healthcare awareness increase, life expectancy at birth and lifetime spans will rise exponentially. Management of hip fractures requires a wide spectrum of approaches, from prevention to postoperative care [6]. The socioeconomic impact of hip fractures is increasing on a worldwide scale, and there is a need to develop preventive strategies [5] as well as evidence-based treatment protocols to minimise the enormous social burden of these fractures. Given that hip fractures are common, costly injuries with a complex treatment journey that is complicated by comorbidities in the elderly patient group, building clinical recommendations is an important and challenging topic if one considers that infrastructures do vary among European countries. These recommendations are therefore proposals for medical treatment in typical situations, and do not constitute legally committing rules to be observed. ESTES study group, proximal femur The European Society for Trauma and Emergency Surgery (ESTES) Study Group was formed in 2014 with the aim of developing ESTES recommendations on proximal hip fractures. After a review of the recent literature and already existing guidelines in several European countries the members of the study group wrote a concept of the different parts of the recommendations. On a consensus meeting in September 2014 in Frankfurt a definitive version of the recommendations was formulated and agreed by all study group members. The recommendations on hip fractures are approved by the ESTES board.