Integrated hip-fracture model cuts mortality rates

A pioneering medical system in Tianjin has treated nearly 4,500 elderly patients with hip fractures in its inaugural year, signaling a potential shift in how China manages the "last fracture of life".

The Tianjin Elderly Hip Fracture Center reported that more than 40 percent of its patients underwent surgery within the critical 48-hour "golden window" — double the rate recorded in the city a decade ago. Data suggest that the rapid intervention model significantly reduces the 30 percent first-year mortality risk associated with elderly hip fractures.

Xu Weiguo, secretary of the Party committee at Tianjin Hospital, which oversees the center, said the progress stemmed from a multidisciplinary team treatment model pioneered by the hospital, which has addressed critical problems such as slow consultations, delayed surgeries and high complication rates in elderly hip fractures.

"Treating hip fractures in the elderly should be completed within 48 hours to reduce complications and mortality. If patients have multiple underlying conditions, preoperative preparation becomes more complex and requires efficient multidisciplinary collaboration," he said.

Compared to hip fracture patients undergoing surgery, those opting for conservative treatment face a 6 — to 15-fold higher mortality rate. "Seizing the critical window for treatment is key to saving the lives and quality of life of elderly patients," he added.

If elderly hip fracture patients fail to undergo surgery in a timely manner, the mortality rate within one year can reach 30 percent.

"Hip fractures are not fatal, but the complications caused by fractures that keep elderly people bedridden are deadly," said Yang Zhao, director of the emergency department at Tianjin Hospital. There are many cases of multiple organ failure caused by delayed treatment, operating as soon as possible is the core principle in treating elderly hip fractures, Yang said.

Elderly hip fractures are often low-trauma injuries that occur in women over 55 years old or men over 60 years old, and are often associated with osteoporosis.

Xu said that the average age of elderly patients with hip fractures is 75.4 years old, and most of them have complications from a variety of basic diseases. Respiratory dysfunction, diabetes and high blood pressure are common.

Previously, orthopedic surgeons had to wait for individual clearances from cardiology, respiratory and endocrinology departments — a process that often took days.

Cheng Jing, a doctor of the Orthopedics department at Tianjin Hospital, said that under the new system, specialists work as a single unit to stabilize patients simultaneously. This coordination allowed an 80-year-old patient with severe heart and lung dysfunction, previously deemed "inoperable" by local hospitals in neighboring Hebei province, to be successfully treated and operated on within two weeks.

"If an elderly hip patient has diabetes, an endocrinologist is asked to give a treatment plan. The follow-up treatment effect is unknown to doctors in other departments," said Cheng. "However, with the multidisciplinary team model, the Tianjin Elderly Hip Fracture Center will make a comprehensive adjustment, and relevant departments will track the treatment effect throughout the process and adjust the treatment plan accordingly. Therefore, the center has the ability to receive patients with more severe and complex conditions."

Since its establishment in 2024, led by Tianjin Hospital, the center has expanded to cover 18 comprehensive hospitals in the city, integrating the Tianjin Emergency Center and Blood Center and enabling the comprehensive linkage of relevant medical resources in Tianjin to facilitate treatment. At present, the "Tianjin Model" for the treatment of hip fractures in the elderly has gradually been promoted in Beijing, Hebei, Henan, Guangxi, Jiangxi, Hubei, Guangdong, and other provinces and cities.

Under this treatment model, rescue personnel from Tianjin's "120" emergency system have become more proficient in carrying out the treatment of elderly hip fractures. After the patient dials the medical emergency number 120, the staff can quickly assess the condition and share patient information through the pre-hospital information platform to ensure timely transfer to the relevant hospital.

Each center optimizes the treatment process, opens a "green channel", and conducts multidisciplinary expert consultations to achieve seamless integration between emergency care and in-hospital treatment.

To extend the treatment effect and promote the recovery of patients after surgery, Tianjin Hospital has reached out to 16 secondary hospitals to establish rehabilitation departments, providing them with training for the rehabilitation treatment of patients, Party secretary Xu said.

"We have also collaborated with community workers and family doctors to promote fall prevention measures for the elderly, reducing the occurrence of hip fractures," he added.

A treatment system centered on elderly hip fractures has been formed, which achieves full process management of pre-hospital emergency, in-hospital surgery, and grassroots rehabilitation through the construction of a three-level diagnosis and treatment system, Xu said.

There are over 1 million hip fractures in China every year, and with rapid population aging, hip fractures in the elderly have become a public health issue.

Wang Xudong, secretary of the Party Committee and chairman of the Tianjin Health Commission, said the city will accelerate the construction and improvement of the treatment system for hip fractures in the elderly, establish a comprehensive rapid treatment network for elderly hip fractures, and promote an integrated project for preventing falls and fractures among the elderly.

"Turning the 'Tianjin Hospital plan' into a 'Tianjin plan' for the treatment of elderly hip fractures will enhance the health level of the elderly population and provide the 'Tianjin experience' for the treatment of elderly hip fractures nationwide," he said.

Wu Meng contributed to this story.