The Orthogeriatric Approach: Progress Worldwide

Abstract

The role of geriatricians in the rehabilitation phase after surgical treatment of fragility fractures, particularly hip fractures, has been accepted for many years, although it has not been widespread in the world because there are many countries where the discipline of geriatric medicine is not yet strongly established. However, it is only in the last 10 years that their role in the acute, perioperative phase has begun to be established. This began in the United Kingdom and has spread, particularly in Europe and Australasia, though there have also been a few important centres of development in the USA, Israel and Singapore. There is an exponentially increasing published evidence base suggesting that orthogeriatric co-management can be both better quality and more cost-effective. It is therefore desirable that this format of service delivery, or a variation of it, should become established in the emerging economies, where the expected rise in fragility fracture incidence will be most severe. Two organisations are actively pursuing that goal: the Fragility Fracture Network and AOTrauma. The UK experience was that continuous, patient-level audit of hip fracture management, with nearly real-time feedback to participants, was a powerful driver of orthogeriatric co-management. That model is being closely followed in Ireland, Australasia and the German-speaking European countries. The Fragility Fracture Network is offering it globally and a pilot in Europe was successful. However, that mechanism has to follow a process of consensus on guidelines and standards that is led by orthopaedics and geriatrics (or its equivalent) but also includes anaesthetists, nurses, physiotherapists, rehabilitationists and osteoporosis specialists. The audit, or an equivalent performance indicator, then measures compliance with those standards and that is one proven driver of positive change. However, the consensus process is the essential first step and is powerful in raising fragility fracture care up the policy agenda.