The National Institute for Health and Care Excellence (NICE) today (10 November) opens the public consultation on its draft guideline on the management of hip fracture in adults. The draft guideline sets out preliminary recommendations on what treatment and care the NHS should offer to people who have had a hip fracture, from the point at which they are admitted to hospital, to their return home, and then final discharge from follow-up care.

Around 70-75,000 hip fractures occur each year in the UK, with figures projected to rise as a result of the ageing population. The average age of a person with hip fracture is 77 years, and most are women. Although most hip fractures occur in later life, they can happen at any age in people who have the bone-thinning conditions osteoporosis or osteopenia. Currently, the cost of medical and social care for the UK's hip fracture cases is an estimated £2 billion each year. A high number of deaths occur after a hip fracture, with around one in three people with a fracture dying within 12 months. Although fewer than half of these deaths are related to the hip fracture itself, it's an indication of the high level of pre-existing illnesses in many patients with hip fracture.

Dr Fergus Macbeth, NICE Clinical Practice Centre Director, said: “Hip fracture is a major health problem which can have a devastating impact on people who suffer one, as well as requiring a carefully coordinated approach from a range of health disciplines including care after leaving hospital. Evidence indicates that there is considerable variation in clinical practice, which can affect the quality of care that hip fracture patients of all ages receive. For example, prompt surgery has been generally recognised as important, but it's sometimes delayed for administrative or clinical reasons. When the final NICE guideline is published, it will help health professionals manage hip fracture in the most effective way. We look forward to receiving comments from groups representing patients and clinicians as part of this public consultation to help inform the development of this important guideline.”

Draft recommendations for consultation include:

• Timing of surgery: Offer patients who require surgery an operation to be carried out on the day of, or the day after, admission, and identify and treat specified correctable co-morbidities immediately so that surgery is not delayed
• Surgical procedures: recommendations on when to offer arthroplasty (joint reconstruction or realignment) and total hip replacements depending on the specific type of hip fracture and patient's individual circumstances
• Mobilisation strategies: Offer patients physiotherapy assessment and, unless medically or surgically contraindicated, mobilisation on the day after surgery, and offer patients mobilisation at least once a day and ensure regular physiotherapy review
• Multidisciplinary management: From admission, offer all hip fracture patients a formal, acute orthogeriatric or orthopaedic ward-based Hip Fracture Programme that incorporates aspects including:
  • early identification of individual goals for multidisciplinary rehabilitation to help patients regain their mobility and independence as quickly as possible, continued regular orthogeriatric and multidisciplinary review
  • continued regular orthogeriatric (joint orthopaedic and geriatric care service) and multidisciplinary review
  • comprehensive information exchange with the patient's primary care team

The consultation on the draft guideline on the management of hip fracture in adults closes on 12 January 2011, and comments from registered stakeholders are welcome via the NICE website.

ENDS

Notes to Editors:

About the guidance

1. The consultation on the draft guideline is available from Weds 10 November 2010 to 12 January 2011.

2. Read the NICE guidance on primary and secondary prevention of osteoporotic fractures at www.nice.org.uk/TA160, www.nice.org.uk/TA161 and www.nice.org.uk/TA204.

About NICE

3. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

4. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS

5. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

6. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

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