David Marsh, MBBCh, MA, MD, FRCS
I am writing my response to this question as the immediate past president of the Fragility Fracture Network (FFN). This global organization exists precisely because there is an abundance of evidence about the delivery of high-quality care to elderly patients with fragility fractures in general and hip fractures in particular. The evidence base for the surgical treatment of hip fractures is fairly comprehensive; although still gradually evolving. However, much more important for the patient are the non-surgical issues around multidisciplinary holistic care in the acute episode, rehabilitation after surgery and prevention of the next fracture. The FFN website provides easy access to the evidence-based guidelines that do exist around the world. See, for example, http://fragilityfracturenetwork.org/global-regions/europe, from where you can access guidelines from the U.K. and Spain. In the members area, there is a comprehensive bibliography of the entire evidence base. A related issue that is steadily becoming more established is that continuous audit of hip fracture care is a powerful driver of improvement in services (see http://fragilityfracturenetwork.org/our-organisation/special-interest-groups/hip-fracture-audit-sig). All these issues will be much debated at the upcoming 4th FFN Global Congress in Rotterdam, which will be the ideal setting in which to raise the possibility of a European standard.
David Marsh, MBBCh, MA, MD, FRCS
Emeritus Professor of Orthopaedics, University College London
Past President, Fragility Fracture Network of the BJD
President, UK Arthritis and Musculoskeletal Alliance
International Ambassador, Bone and Joint Decade
Disclosures: Marsh reports he taught on fragility fracture courses organized by Biomet and Lilly, for which he received honoraria.
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