Author: Maria Bonnici
Origin/Affiliation:
Lubov Matchekhina and I, Maria Bonnici, virtually attended the 10th Fragility Fracture Network Global Congress as part of the Early Careers Geriatrics Initiative (ECGI) reporter’s group (EuGMS). The congress was held both on-site and virtually between the 20th and the 22nd of October 2022. This congress featured a multi-disciplinary international plenary of speakers from across the world.
Most of the sessions were live-streamed and after the congress they were also available on the congress’s virtual portal. This made it easier for those who could not watch the sessions live. The virtual platform was very user friendly. In the below sections I highlighted some of the sessions which I personally found interesting and informative.
What are the latest updates on the management of a hip fracture? This was discussed in the plenary session “Cochrane and Beyond” by Prof. Xavier Griffin. He introduced the ‘Cochrane hip fracture in older adults updates’ found on the Barts Bone and Joint Health’s website. Hip fracture is the focus of 29 separate Cochrane Reviews with considerable ongoing research. The evidence shows that peripheral nerve blocks in hip fracture reduced pain on movement within 30 minutes after the block, decreased delirium, time to first mobilisation and probably also reduced the risk of pneumonia. With regard to the general vs spinal anaesthesia, spinal anaesthesia was not found to be superior to general anaesthesia for survival and ambulation. The incidence of delirium was similar in the two groups. It was shown that for hip fracture, a cemented prosthesis will yield an improved global outcome and there was no evidence to suggest a bipolar is superior to a unipolar prosthesis. Moreover, any benefit of total hip arthroplasty compared with a hemiarthroplasty was likely to be small and not clinically significant.
What is the optimal surgical timing for patients taking DOACs? This was thoroughly discussed in an interactive workshop. DOACs are being used more frequently and Dr. Seth Terrant presented a literature review which concluded no evidence for deliberately delaying surgery in patients taking DOACs who present with a fracture. Prof. Antony Johansen explained that around 4 years ago, in the United Kingdom, it was normal to wait 48 hours before operating these patients. Nowadays, the UK consensus is to wait 24 hours before operating. Dr. Amy Mayor explained how implementing a guideline in Carderdale and Huddersfield NHS Foundation Trust (UK), has reduced unnecessary delays due to DOACS since June 2017.
In the last plenary session the “World Falls Guidelines for Prevention and Management for Older Adults: A Global Initiative” were presented by Prof. Montero-Odasso. These guidelines were developed by the World Falls Task Force, which assembled 96 multidisciplinary experts from 39 countries and also a panel of older adults. The mission was to create a standardized clinical practice guideline that can be adapted and used in different settings and countries. Some of the key messages include the following:
Opportunistic case findings is necessary as older adults may not present following a fall and may be reluctant to report falls.
Low risk does not mean that there is no risk of falls as up to 30% of community dwelling older adults who fall do not have a h/o falls or gait/balance problems. These falls are not benign, as 60% of patients have associated injuries.
Engaging older adults themselves is an integral part of preventing falls, and understanding their beliefs, attitudes and priorities is key for successfully intervening.
After a hip fracture, older adults should be offered an individualized and progressive exercise program. . A 3i hip FLS with nurse and physician co-management is cost-effective when implemented as a standard clinical program.
The focus for fracture prevention should target bone health and falls prevention together.
Overall, the congress was engaging and highly interesting and we definitely recommend people to attend next year. This will be held in Oslo between the 3rd and 6th of October (2023).
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