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Recent Management of Hip Fractures
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Recent Management of Hip Fractures

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (20 July 2026) | Viewed by 2717

Editor

Dr. Toshiyuki Kawai

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, Kyoto University, Kyoto 606-8501, Japan
Interests: total hip arthroplasty; hip dysplasia; hip–spine syndrome; spinopelvic mobility; titanium metal; bone healing; angiogenesis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As populations age worldwide, the incidence of hip fractures is rising sharply—the risk of femoral neck fracture roughly doubles with each decade after age 50. These injuries are strongly linked to osteoporosis and falls, and they carry high morbidity and mortality (one-year mortality rates up to ~30%). Many survivors never regain their prior level of mobility or independence, underscoring the urgent need for better prevention and treatment strategies. Preventing hip fractures remains a major challenge, highlighting the importance of improved osteoporosis management and fall-prevention initiatives. Once a fracture occurs, optimal outcomes demand a comprehensive approach: older hip fracture patients often have complex comorbidities requiring coordinated care by orthopedic surgeons, geriatricians, rehabilitation specialists, and other professionals. Furthermore, determining the best surgical management (e.g., internal fixation vs. hemiarthroplasty or total hip replacement) for each patient is an ongoing concern in the field.

This call for papers for the Special Issue entitled Recent Management of Hip Fractures seeks to gather diverse perspectives and solutions to these challenges. We particularly welcome submissions on osteoporosis management, fracture prevention strategies, multidisciplinary models of fracture care, and innovations in the surgical treatment of hip fractures. We invite a broad range of contributors, including orthopedic surgeons, rehabilitation specialists, geriatricians, osteoporosis experts, and researchers in related fields, to share their latest findings and insights.

Dr. Toshiyuki Kawai
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hip fracture
  • internal fixation
  • hemiarthroplasty
  • arthroplasty and fixation
  • osteoporosis management
  • fracture prevention
  • multidisciplinary care
  • surgical treatment
  • rehabilitation strategies

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Published Papers (4 papers)

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Research

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12 pages, 818 KB  
Article
The Association Between Preoperative Mobility and 1-Year Survival Following Hip Fracture Surgery: A Nationwide Population Study
by Sharon Groen, Hanne-Eva van Bremen, Jasper van Hees, Ellie B. M. Landman, Elvira R. Flikweert and Stijn A. A. N. Bolink
J. Clin. Med. 2026, 15(5), 1764; https://doi.org/10.3390/jcm15051764 - 26 Feb 2026
Viewed by 516
Abstract
Background/Objectives: Decreased preoperative mobility increases the risk of decline and postoperative mortality in a frail patient with a hip fracture. This study investigates the correlation between preoperative mobility and 1-year mortality and between pre- and postoperative mobility. Methods: This retrospective, national cohort [...] Read more.
Background/Objectives: Decreased preoperative mobility increases the risk of decline and postoperative mortality in a frail patient with a hip fracture. This study investigates the correlation between preoperative mobility and 1-year mortality and between pre- and postoperative mobility. Methods: This retrospective, national cohort study used data from the Dutch Hip Fracture Audit (2018–2023). Excluded patients were those with an indication for a total hip arthroplasty, non-surgical treatment or missing data on mortality or preoperative mobility. Mobility was determined by the Fracture Mobility Score (FMS). A Cox proportional-hazards regression model assessed the correlation between FMS and mortality by using hazard ratios with 95% confidence intervals. A subgroup analysis was conducted for patients whose data on postoperative mobility was complete. Spearman’s test was used to assess the correlation between pre- and postoperative mobility. A p-value < 0.05 was considered statistically significant in both analyses. Results: A total of 77,185 patients were included in the study. A Cox regression model shows a stepwise increase in risk of death with a lower preoperative FMS, after correction of confounders. Those with no functional mobility showed the highest risk of death within 1 year after surgery (HR 1.86, 95% CI 1.65–2.09, p < 0.001). Spearman’s correlation demonstrated a moderate positive correlation between pre- and postoperative mobility, which is demonstrated by ρ = 0.49 (p < 0.001). Conclusions: Preoperative mobility seems to be an independent predictor of 1-year mortality. Additionally, this study demonstrated a moderate positive correlation between pre- and postoperative mobility. Full article
(This article belongs to the Special Issue Recent Management of Hip Fractures)
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11 pages, 3475 KB  
Article
Preoperative Pain Control for a Femoral Neck Fracture Using Intra-Articular Multimodal Drug Injection
by Konlawat Sabsuantang, Siraphat Ponghunsa, Jinnipa Arunothai, Vachirasorn Anannor, Atikun Natee and Paphon Sa-Ngasoongsong
J. Clin. Med. 2026, 15(5), 1762; https://doi.org/10.3390/jcm15051762 - 26 Feb 2026
Viewed by 667
Abstract
Background/Objectives: Hip fractures among elderly patients are associated with significant morbidity and mortality. Delayed surgery is common and often results in inadequate pain control and increased opioid consumption, which may have adverse effects. This study evaluates the effectiveness of preoperative intra-articular injection of [...] Read more.
Background/Objectives: Hip fractures among elderly patients are associated with significant morbidity and mortality. Delayed surgery is common and often results in inadequate pain control and increased opioid consumption, which may have adverse effects. This study evaluates the effectiveness of preoperative intra-articular injection of multimodal analgesics (IA MDI) for reducing pain caused by a displaced femoral neck fracture (FNF). Methods: A prospective randomized controlled trial was conducted using 18 geriatric patients with displaced FNFs scheduled for hip arthroplasty. The patients were randomized into two groups: IA MDI and control groups (n = 9 each). The IA MDI group was administered a preoperative intra-articular injection of ropivacaine, morphine, and adrenaline, in addition to standard oral and intravenous (IV) analgesics, while the control group was administered standard oral and IV analgesics alone. The primary outcome was the perioperative pain score assessed via the 10-point numerical rating scale (NRS). The secondary outcomes were morphine consumption, perioperative complications, length of hospital stay, and functional outcome. Results: During the first 24 h preoperative period after admission, the IA MDI group exhibited a significant reduction in the average NRS at all timepoints (p < 0.05 all) and in the median dosage of morphine consumption (0 mg vs. 6 mg, p = 0.033) compared to the control group. There was no significant difference between groups in terms of postoperative pain and complications, length of hospital stays, or functional outcomes (p > 0.05 all). Conclusions: Preoperative IA MDI significantly reduced pain intensity and opioid consumption during the preoperative 24 h window among elderly patients with FNFs without provoking a corresponding increase in observed complications in this pilot randomized controlled study. IA MDI is a feasible option and could be a useful adjunct for preoperative pain management for FNFs. Full article
(This article belongs to the Special Issue Recent Management of Hip Fractures)
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14 pages, 888 KB  
Article
Transition from Straight Lateral to Direct Anterior Approach in Hip Hemiarthroplasty: Preservation of Independent Living and Lower 1-Year Mortality
by Jasper van Hees, Lambert C. E. Visser, Sharon Groen, Ellie B. M. Landman and Stijn A. A. N. Bolink
J. Clin. Med. 2026, 15(4), 1533; https://doi.org/10.3390/jcm15041533 - 15 Feb 2026
Viewed by 721
Abstract
Background/Objectives: Hip hemiarthroplasty (HHA) for femoral neck fractures (FNFs) can be performed via the posterolateral approach (PLA), straight lateral approach (SLA) or direct anterior approach (DAA). However, the optimal approach remains unclear. This study evaluated mortality and return-to-home rates following an institutional [...] Read more.
Background/Objectives: Hip hemiarthroplasty (HHA) for femoral neck fractures (FNFs) can be performed via the posterolateral approach (PLA), straight lateral approach (SLA) or direct anterior approach (DAA). However, the optimal approach remains unclear. This study evaluated mortality and return-to-home rates following an institutional transition from SLA to DAA. Methods: This retrospective observational cohort study included patients who underwent primary cemented unipolar hip hemiarthroplasty for FNF during a period of transition in surgical approach (2015–2023). Clinical outcomes between the straight lateral and direct anterior approach were compared. Primary outcomes were the mortality and return-to-home rates. Secondary outcomes included perioperative parameters and complications. A subgroup analysis was performed using Fracture Mobility Score (FMS) and Katz activities of daily living (ADL) index to compare functional outcomes. Results: Over a 9-year period, a total of 762 HHA were performed, of which 411 SLA and 333 DAA. Mortality at 90 days (14.1% vs. 8.7%, p = 0.029) and 1 year (26.5% vs. 17.7%, p = 0.005) were significantly higher in the SLA group. Among patients living at home preoperatively, return-to-home after surgery was lower for SLA compared to DAA (23.2% vs. 41.4%, p < 0.001). In terms of complications, SLA had significantly lower rates of periprosthetic joint infections (SLA n = 6 (1.5%) vs. DAA n = 15 (4.6%), p = 0.024). The decline in Katz ADL score at three months was significantly greater in the SLA group than in the DAA group (ΔKatz ADL −0.73 ± 1.57 vs. −0.11 ± 1.60, p = 0.036). Conclusions: Transitioning from SLA to DAA in HHA was associated with improved preservation of independent living, higher return-to-home rates and lower 90-day and 1-year mortality. However, DAA was also associated with higher rates of PJI. Full article
(This article belongs to the Special Issue Recent Management of Hip Fractures)
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Review

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44 pages, 645 KB  
Review
Preventing Hip (Proximal Femoral) Fractures: An Evidence-Based Review for Clinicians
by Toshiyuki Kawai, Yaichiro Okuzu, Yusuke Takaoka, Daichi Natsume and Shuichi Matsuda
J. Clin. Med. 2026, 15(16), 6148; https://doi.org/10.3390/jcm15166148 - 7 Aug 2026
Viewed by 237
Abstract
Hip fractures are among the most devastating fragility fractures, associated with excess mortality, disability, loss of independence, and substantial healthcare costs. Although age-standardized incidence has declined in several high-income countries, absolute case numbers continue to rise because of population aging. This review summarizes [...] Read more.
Hip fractures are among the most devastating fragility fractures, associated with excess mortality, disability, loss of independence, and substantial healthcare costs. Although age-standardized incidence has declined in several high-income countries, absolute case numbers continue to rise because of population aging. This review summarizes contemporary PubMed-indexed evidence on the epidemiology, risk stratification, and prevention of proximal femoral fractures, with emphasis on hip-fracture outcomes rather than vertebral or composite endpoints alone. We discuss secular trends, FRAX-based case findings and screening, non-pharmacologic strategies, pharmacologic therapy, and health-system interventions relevant to both primary and secondary prevention. Among non-pharmacologic measures, long-term balance-challenging and resistance-based exercise has the most consistent evidence for reducing falls and likely contributes to fracture prevention, whereas multifactorial interventions, home hazard modification, calcium/vitamin D supplementation, and hip protectors are best targeted to selected high-risk populations and care settings. Among medications, bisphosphonates, denosumab, and romosozumab-based sequential strategies show the strongest evidence for reducing hip-fracture risk, while teriparatide and abaloparatide have important roles in very-high-risk patients despite less direct hip-fracture evidence. Menopausal hormone therapy reduces hip fractures in younger postmenopausal women but is limited by extra-skeletal risk, and selective estrogen receptor modulators are primarily vertebral-fracture agents. A major message of this review is that effective prevention depends not only on drug efficacy but also on implementation. Fracture liaison services, orthogeriatric co-management, prompt treatment after fragility fracture, and sustained adherence support are essential to close persistent care gaps. Preventing hip fractures therefore requires an integrated, risk-stratified approach that combines skeletal protection, falls prevention, and reliable health-system delivery. Full article
(This article belongs to the Special Issue Recent Management of Hip Fractures)
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