Orthogeriatric care in patients with fractures of the proximal femur.

How are we to cope with the complex problems that now surround elderly patients with fractures? What are these problems and what systems should be in place to address them? No matter how successful we may be in treatment of osteoporosis and prevention of falls, it is inevitable that a massive worldwide increase in incidence of fragility fractures will occur in the next 50 years. It is crucial that we upgrade our systems to cope with this, if severe disruption of health services is to be avoided. This review considers the topics of falls, osteoporosis, and impact modification. We review the major medical issues that should be addressed in delivering hospital care that is efficient and of high quality. Various models for organizing the necessary liaison between fracture staff and medical or geriatric staff are examined and the current literature regarding orthogeriatric care is reviewed. We propose that the model of continuous orthogeriatric care, as practiced in Belfast, may be the way forward in addressing the complex problems associated with elderly patients with fractures. A system of ongoing audit of treatment outcomes and the journey of care for elderly patients with fractures of the proximal femur is necessary as a monitoring tool in developing the optimal system for orthogeriatric liaison.