Injury - 2026-08-19 - Journal Article
Operative and non-operative management of people with hip fracture: A modified-Delphi study to develop an international consensus.
Mitchell RJ, Johansen A, Willems HC, Tabu I, Seymour H, Moppett I
Topics
Key Takeaway
A 2-round modified-Delphi across 17 countries achieved high consensus (≥70% agreement) on 14 of 15 statements guiding operative versus non-operative hip fracture management, with only 24% of participating facilities having a formal non-operative protocol.
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Summary
This modified-Delphi study convened an international, multidisciplinary panel—anaesthetists (30%), orthopaedic/trauma surgeons (28%), and geriatricians (27%)—to generate consensus statements on operative versus non-operative hip fracture management, particularly for end-of-life patients. Across two rounds, 14 of 15 statements reached high consensus (≥70%) and one reached moderate consensus (50–69%). The finding that only 24% of facilities had a formal non-operative protocol underscores the gap this consensus aims to address.
Key Limitation
The absence of patient and family representatives from the panel limits the applicability of these consensus statements to true shared decision-making, which is the stated goal of the framework.
Original Abstract
OBJECTIVE
To develop a series of consensus statements regarding the operative and non-operative management of hip fracture patients.
METHOD
A two-round modified-Delphi study was used to obtain consensus on statements for the the operative and non-operative management of hip fracture patients. Panel members rated the importance of each statement to guide the decision to operatively or non-operatively treat hip fracture patients. High consensus was defined as agreement of ≥ 70% and moderate consensus 50-69% between participants.
RESULTS
There were 67 round 1 and 55 round 2 panellists. Panellists were working across 17 countries and commonly were anaesthetists (30%), orthopaedic or trauma surgeons (28%), or geriatricians (27%). Just less than one-quarter of panellists (24%) indicated the facility they predominately worked in had a protocol for the non-operative management of hip fracture patients. At the conclusion of the modified-Delphi study, 14 (93%) statements achieved high consensus and one (7%) statement moderate consensus.
CONCLUSION
The consensus statements are intended to support shared decision-making regarding non-operative hip fracture care and to promote a more consistent approach to the management of older adults with hip fracture at the end of life. Ultimately, the decision for operative or non-operative management should be made based on each patient's individual circumstances.