Fragility Fractures
Conditions
Brief summary
Fragility fractures, also known as osteoporotic fractures, are fractures that occur as a result of low-energy trauma or minor impact. They are the most serious complication of osteoporosis and are common bone diseases in the elderly. With our country gradually entering the aging society, the incidence of brittle fracture is increasing year by year, most often in the hip. Hip fracture refers to femoral neck, intertrochanteric and subtrochanteric fractures. Due to a series of complications caused by old age, weak body, many underlying diseases, significant decline in self-care ability and other reasons, it is also known as the last fracture in life. According to reports, within 1 year after hip fracture, only 30% of patients can recover to the functional state before fracture, 20% of patients will fracture again, and even cause lifelong disability, seriously affecting the long-term quality of life of patients, the reason may be related to the long course of disease, slow recovery, postoperative nutrition, rehabilitation exercise compliance, self-care ability decline and many other aspects. The fracture liaison service (FLS) is a nurse-centric, multidisciplinary approach to managing osteoporotic fractures that consists of three key elements: The core of identifying patients with fracture risk, assessing fall risk and initiating treatment to prevent refracture is to hire specialized coordinators to link emergency, orthopedics, rehabilitation, nutrition and other departments with community and family services to provide standardized management services for patients, reduce the incidence of refracture and promote the recovery of joint function of patients. Therefore, this study integrates FLS with Internet + nursing service and utilizes the advantages of Internet + nursing service in informatization to emphasize the risk assessment of re-fracture of patients at home after discharge, home health guidance (such as fall prevention, rehabilitation training and other related knowledge), online consultation of multidisciplinary teams, offline on-site service, etc., so that patients can be discharged from hospital. Access to ongoing medical care reduces the incidence of complications and promotes rapid recovery.
Detailed description
Osteoporotic fractures, also known as fragility fractures, refer to fractures occurring due to low-energy trauma or minor collisions. As the most severe complication of osteoporosis, they are common skeletal diseases in the elderly population . With China's gradual transition into an aging society, the incidence of fragility fractures has increased annually. Hip fractures, the most common type of fragility fracture, involve injuries to the femoral neck, intertrochanteric, and subtrochanteric regions of the femur . Referred to as the last fracture in life, hip fractures are associated with high morbidity and mortality due to complications arising from advanced age, frailty, multiple comorbidities, and significant declines in self-care ability . Reports indicate that within one year of a hip fracture, only 30% of patients regain their pre-fracture functional status, 20% experience subsequent fractures, and some even face lifelong disability , severely impacting long-term quality of life. These statistics underscore the critical need for standardized management of hip fragility fractures. Studies have reported that ineffective rehabilitation guidance, insufficient knowledge of rehabilitation training, and lack of scientific self-care capabilities are key factors influencing postoperative recovery in fragility fracture patients . Continuous nursing care, which addresses gaps in in-hospital health education, has become an indispensable component of postoperative care . Since 2015, nursing informatization has been promoted by national policies and plans, emerging as a major trend in nursing development . Driven by rapid technological advancements, the healthcare sector is encouraged to leverage Internet+ Nursing Services to explore new models of continuous care . This model, characterized by online application and offline service, caters to discharged patients or individuals with mobility limitations, meeting their 刚需 for professional nursing services . As a vital component of continuous care, Internet+ Nursing Services play a positive role in rehabilitation guidance and enhancing patient self-management, improving nursing efficiency . However, current challenges exist: most services are provided by part-time clinical nurses without advanced education or referral coordination skills , and physician involvement is limited, leading to incomplete patient assessments during follow-ups. Additionally, reliance on mobile calls and WeChat for follow-ups raises concerns about information reliability. Thus, enhancing the quality of Internet+ Nursing Services for hip fragility fracture patients remains a critical clinical issue. The fracture liaison service (FLS) is a multidisciplinary management model for osteoporotic fractures , comprising three key elements: identifying patients at fracture risk, assessing fall risk, and initiating treatments to prevent recurrent fractures. Its core involves dedicated coordinators linking emergency, orthopedic, rehabilitation, nutrition, and community services to provide standardized care, reducing fracture recurrence and promoting functional recovery. While FLS has been widely applied in fragility fracture care, its integration with remote nursing remains limited. This study aims to combine FLS with Internet+ Nursing Services, leveraging the informatic advantages of the latter to emphasize post-discharge risk assessment for recurrent fractures, home-based health guidance (e.g., fall prevention, rehabilitation training), online consultations with multidisciplinary teams, and offline home visits. By ensuring continuous medical care after discharge, this integrated model seeks to reduce complications and facilitate rapid recovery.
Interventions
OTHEROn the basis of routine nursing, the Internet + nursing program based on the FLS model is implemented
1\) During hospitalization: After the patient is admitted to hospital, the coordinator will establish wechat contact with the patient face to face and establish a good trust relationship with the patient; The coordinator and the doctor will collect the patients' cases together, and then according to the patients' conditions and wishes, the diagnosis and treatment plan will be formulated jointly by multiple disciplines, including medicine, rehabilitation and nutrition management. 2) Before discharge: the coordinator helps the patient to make an appointment for return visit; Issue business cards of the team's online and offline services to patients and guide them to use wechat and online service application procedures (such as Zheli Care and Dr. Nari); 3) After discharge: patients keep in touch with the liaison staff at any time, and any abnormal situation will be contacted by the liaison staff; Team members supervised the patient's medication situation by punching in the mini program
Sponsors
The Fourth Affiliated Hospital of Zhejiang University School of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Age ≥ 18 years Voluntarily signed informed consent Diagnosis of hip fragility fracture (closed type) Scheduled for surgical intervention Adequate communication and comprehension abilities Ability of patient or caregiver to operate smart electronic devices
Exclusion criteria
History of psychiatric or neurological disorders (e.g., dementia, schizophrenia) Polytrauma (multiple fractures or major concomitant injuries) Metastatic cancer, metabolic bone disease, or terminal illness Insulin-dependent diabetes mellitus Thyroid disease Inability to participate due to other medical or social factors
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Daily Living Ability Rating Scale (ADL) | 2 weeks, 1 month, 3 months after discharge | Activities of Daily Living (Barthel Index): Used to assess patients' ability to perform daily living activities. The assessment includes: eating, bathing, grooming, dressing, toileting, mobility, bed-chair transfer, stair climbing, and bowel/bladder control. A total score of 100 indicates complete independence without reliance on others; 61-99 points indicate basic independence in daily life; 41-60 points indicate moderate dependence requiring assistance; 21-40 points indicate significant dependence on others for daily activities; and ≤20 points indicate complete dependence on others. |
| Harris Hip Joint Function Scale | 2 weeks, 1 month, 3 months after discharge | Harris Hip Rating Scale: This study uses the Harris Hip Rating Scale, the most widely applied hip assessment tool in North American hip scoring criteria. Developed by Harris in the United States in 1969, the scale consists of 10 items with respective maximum scores as follows: Pain (44 points), Stair climbing (4 points), Putting on and removing shoes and socks (4 points), Sitting in a chair (5 points), Car travel (1 point), Gait (11 points), Walking aid use (11 points), Walking distance (11 points), Deformity (4 points), and Range of motion (5 points). The total score is 100 points, categorized into four grades: excellent (90-100 points), good (80-90 points), fair (70-80 points), and poor (below 70 points). |
| Complications | 2 weeks, 1 month, 3 months after discharge | Complications (incidence of recurrent fractures, infection, pressure ulcers, dislocation, etc.). |
Countries
China
Contacts
Primary ContactCheng li Yan, Bachelor
Backup ContactYu yu Chen, Master
Outcome results
None listed