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This work seeks to assess the possible contribution of hospitalization to hip fractures sustained in an acute care hospital and to determine the need for hospital care for these patients at the time of the fracture. Between 1988 and 1997 there was an average of 399 falls and four in‐hospital hip fractures per year. For 14 percent, no predisposing factors for falling were noted, 38 percent of the fractures occurred within the first three days and 47 percent during the first week of hospitalization. Original admission did not seem warranted for 10 percent and 48 percent no longer required inpatient care at the time of the fracture. Most fractures occur early during hospitalization; some patients seem to have no predisposing factors for falling and about one‐half may not require hospitalization at the time, all implicating hospitalization as a causative factor.

Fracture experiments on real human bodies to examine the protected positions and protective devices for the development of protective clothing to manage fractures is exceedingly difficult. Thus, the experimental design will have limitations, more of which are imposed if subjects are elderly people. To circumvent these limitations, this study proposes a finite element model of the hip joint in elderly women with virtual impact simulations that can replace actual fall and impact tests, and examine the positions and characteristics of fractures resulting from taking a fall.

The hip joints were modeled after the average horizontal surface size and cross-sectional shapes of the lower extremities (waist to knee) in 439 elderly Korean women in that age group. The model was composed of bones, cartilages, and soft tissue.

The fracture was examined by comparing the maximum stress on the hip joint by applying a point force to its adjacent surface. The vulnerable part in the hip joint neck with a high risk of fracture risk on an impact could be determined and used to set the protective device attachment position.

It is significant that this study has developed a partial model of the human body that can be used for a relatively simple simulation by minimizing the highly complex human body as much as possible. Furthermore, the model is easily applicable to the designing of protected positions and protective devices for the development of special clothing, for hip joint fracture prevention.

The objective of the project was to achieve enhanced quality and efficiency of care to patients with hip fracture in an orthopaedic department at a county hospital in southern Sweden. A further aim was to create better use of resources by identifying and dealing with problems and no‐value‐added activities. The project adopted an approach based on the stages of Business Process Improvement, with the main outcome measures including flow charting overview and block diagram, process‐walking‐through, effectiveness, efficiency, and adaptability measurements and targets, observations and interviews with patients, relatives and professionals, and examination of care plans. Results showed that the care of patients with hip fracture can be improved, but that this would involve better collaboration among different professions and disciplines, standard care plans, and improved status for the patients.

The purpose of this paper is to describe and explain a clinician‐led improvement of a hip fracture care process in a university hospital, and to assess the results and factors helping and hindering change implementation.

The paper has a mixed methods case study design. Data collection was guided by a framework directing attention to the content and process of the change, its context and outcomes.

Using a multiprofessional project team, beneficial changes in the early parts of the care process were achieved, but inability to change surgical staff work practices meant that the original goal of operating patients within 24 hours was not reached. After three years, top management introduced a hospital‐wide process improvement programme, which “took over” the responsibility for improving hip fracture care.

A clear vision why change is needed and what needs to be done, which is well communicated by a respected clinical leader, can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services.

This case study is an illustration of both the strengths and the weaknesses of a “bottom‐up, clinician‐champion‐led improvement initiative” in a complex university hospital.

The hip fracture “best practice tariff” (BPT) came into effect in April 2010. It advocated two key improvements: surgery within 36hrs of arrival in the emergency department; and multi-disciplinary care directed by ortho-geriatrician from admission to discharge. The aim of this paper is to look at the 36 hours to operation target and its implications for orthopaedic department trauma service staff in a busy district general hospital, and to evaluate the measures implemented to meet the target.

Trauma-list data, collected from a theatre management system, was compared with trauma patients placed on elective and emergency lists, before and after designated daily trauma lists were implemented.

After a designated daily trauma list was introduced, a significant rise (from 56 per cent to 85 per cent) became evident in the proportion of patients operated on within 36hrs, between November 2010 to February 2011, while hip fracture cases managed on the elective list fell from 24 per cent to 17 per cent.

Despite adding a half-day trauma list, the trauma service has insufficient capacity to achieve the new BPT for all hip fracture patients in the hospital. Therefore, there is a significant knock-on effect for managing patient overspill on elective services. Will the significant changes in service provision designed to achieve this BPT be cost effective?

This paper aims to answer how busy department staff address an issue that professionals in every English hospital are facing.

To analyse the implementation of fast‐tracking pathway of hip fractures from accident and emergency to the orthopaedic wards.

A retrospective audit analysing 100 case notes of fast‐tracked hip fractures selected at random for the period of one year was undertaken.

Several deficiencies were identified in the implementation of the pathway.

Recommendations have been made for correction of the inadequacies identified.

This paper aims to increase the efficiency and safety of fast‐tracking system for hip fractures, which is being deployed by many hospitals throughout the UK.

This paper aims to examine the influence of hip protective clothing on ensemble performance attributes related to thermal comfort. It also explores the effect on protective pads of various materials and the arrangements of material. The thermal comfort characteristics are thermal insulation and moisture vapour resistance.

For this research, four ensembles of clothing were used: one ensemble without hip protective clothing and three ensembles with hip protective clothing. A thermal manikin was used to test the thermal insulation and moisture vapour resistance of the ensembles.

The findings revealed that incorporating hip protective clothing into the clothing ensembles influenced the thermal resistance and moisture vapour resistance of the ensemble. In the “all zones group,” the influence of the hip protective clothing depended on clothing style, with hipster-style clothing producing insignificant changes. In the “hip zones group” and “stomach and hip zones group,” hip protective clothing strongly influenced the thermal comfort attributes of ensembles. Pad material and volume play important roles in these changes in thermal comfort attributes.

These outcomes are useful for the design and engineering of hip protective clothing, where maximizing protection while minimizing thermal and moisture vapour resistance is critical for wear comfort and adherence in warm or hot conditions. The designer should consider that material, volume and thickness of protective pad affect the overall thermal comfort attributes of the hip protective clothing.

Osteoporosis demands systematic management for optimum use of resources. Guidelines from the Primary Care Rheumatology Society (PCRS) aim to improve its diagnosis and treatment. We identified all admissions over three months to a district general hospital of patients with fracture of femur, vertebra, or distal forearm and of women who underwent oophorectomy or hysterectomy. We audited their care using the criteria that the diagnosis and risk of osteoporosis should be recorded; that management should follow PCRS guidelines; and that this information should be communicated to general practitioners. An ideal standard of 100% compliance with these criteria was chosen. Overwhelmingly these audit criteria were not met, the only one that was met being the prescription of hormone replacement therapy after oophorectomy. Potential for prevention of 35% of hip and distal forearm fractures was identified, the commonest risk factor being long‐term corticosteroid therapy. Identification of high risk patients is feasible by simple methods and their management needs improvement. We suggest that a ‘long‐term corticosteroid therapy register’ and a dedicated ‘osteoporosis service’ would facilitate this.

The purpose of this paper is to explore the whole system cost of the care pathway for older people (aged 65-years old and over) admitted to hospitals as a result of falls in Torbay, a community of 131,000 in the southwest of England with a high proportion of older residents, over a two-year period.

The paper analysed patient-level linked acute hospital, community care and local authority-funded social care data to track patients’ care costs – for those patients admitted to an acute hospital due to their fall – in the 12 months before and after their fall.

On average, the cost of hospital, community and social care services for each admitted for a fall were almost four times as much in the 12 months after admission, than the cost of the admission itself. Over the 12 months that followed admission for falls, costs were 70 per cent higher than in the 12 months before the fall. The most dramatic increase was in community health care costs (160 per cent), compared to a 37 per cent increase in social care costs and a 35 per cent increase in acute hospital care costs. For patients who had a minor fall and those who survived 12 months after the fall, the costs of care home services increased significantly; for patients with hip fracture, the costs of community care services increased significantly; for patients who did not survive 12 months after the fall, the cost of acute inpatient and community health visits increased significantly.

This is the only study that has assessed the costs across the acute hospital, community care and social care pathway for this group of patients, in an English population. This will help commissioners and providers understand and develop better-integrated responses to frail elderly patients needs.

The purpose of this paper is to report a rare case of segmental neck of femur fracture (SNoFF) and highlight its quality assurance and governance implications with respect to national guidelines, care pathways and best practice tariff.

Case report of an SNoFF in a 67-year-old woman treated at a district general hospital (DGH) was used in this study.

SNoFF required additional implants that delayed the surgery by five days. The authors were unable to adhere to the British Orthopaedic Association standards for trauma and Scottish Inter-Collegiate Guidelines Network recommendations which indicate that all neck of femur fractures (NoFFs) be fixed within 48 h. Though the patient was discharged without any untoward event and had an uneventful recovery, this case led us to introspect and learn how best to avoid such an incident from repeating again.

This case led to an overhaul of NoFF and trauma services. The local logistics was restructured to procure “Trochanteric grip plates” within 24 h to provide mandated quality of care in an effort towards improving patient experience/outcomes.

SNoFF are rare injuries and its diagnosis is either delayed or missed in at least 20 per cent of the cases on initial evaluation. The non-availability of additional implants readily on the shelf coupled with lack of a trauma bed at the tertiary centre resulted in an unacceptable delay from admission to definitive surgery. The authors recommend that all DGHs have a mechanism/emergency procurement procedure system in place to obtain the required instrumentation kits rapidly through a sharing scheme with regional hospitals or through implant vendor to avoid unacceptable delays to surgery.