J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01304. Online ahead of print.

ABSTRACT

BACKGROUND: Researchers employ murine fracture models to study bone healing, but the temporal relationship between mouse and human fracture healing is poorly understood. The hypothesis of this study was that it was possible to quantify specific post-fracture time frames corresponding to the stages of endochondral ossification in both mice and humans.

METHODS: Radiographs of mice and human femoral fractures treated with intramedullary stabilization were reviewed. The study included 330 human femoral fractures (OTA/AO 32A, B, or C injuries) that ultimately healed without complications in patients aged 18 to 55 years and 309 surgically created midshaft femoral fractures in 3-month-old C57BL6/J mice. Multiple orthopaedic surgeons assessed the radiographs using the Modified Radiographic Union Score for Tibia (mRUST). A 4-parameter log-logistic curve was fit to describe fracture healing over time, with 3 parameters allowed to vary: Y∞ (mRUST score at time = ∞), k (healing rate in [1/log(time)]), and X0.5 (time to half-healing).

RESULTS: The values (and 95% confidence interval) for the mice were Y∞ = 14.70 (14.54 to 14.87), k = 4.54/log(days) (4.30 to 4.77), and X0.5 = 11.77 days (11.56 to 11.98). For the humans, the values were Y∞ = 16.78 (16.21 to 17.36), k = 1.37/log(days) (1.28 to 1.45), and X0.5 = 91 days (83 to 99). All parameters differed significantly between the mice and humans (p < 0.05).

CONCLUSIONS: Using mRUST scoring and mathematical modeling, we were able to quantify and compare the temporal progression of fracture healing in mice and humans.

CLINICAL RELEVANCE: These data are relevant for designing and/or interpreting fracture healing studies of mice and humans to promote rational translation of fracture research between species.

PMID:40638717 | DOI:10.2106/JBJS.24.01304

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01293. Online ahead of print.

ABSTRACT

BACKGROUND: Orthopaedic surgeons routinely delay surgical management of femoral neck fractures in patients taking direct oral anticoagulants (DOACs) to decrease perioperative bleeding and associated complications. However, this practice contradicts the principles of hip fracture management, as early surgery is associated with morbidity and mortality benefits. The purpose of this study was to quantify the association of DOAC use and perioperative outcomes in patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for femoral neck fractures. We hypothesized that early surgical intervention on a patient taking a DOAC medication would not lead to worse perioperative outcomes.

METHODS: A retrospective cohort study was conducted on 2,833 patients who underwent primary THA or HA for femoral neck fractures between December 31, 2017, and January 29, 2024, across our hospital system. The patients taking a DOAC were divided into 3 groups based on the time since the last DOAC intake: 1 day, 2 days, and ≥3 days. Propensity matching was performed 1:1, accounting for age, sex, Elixhauser Comorbidity Index, preoperative chronic kidney disease stage, preoperative hemoglobin, body mass index, and hospital type. Subanalyses utilizing linear and conditional logistic regression models were performed to assess differences in outcomes between the groups that had a DOAC withheld and the control groups.

RESULTS: The mean age of all patients was 81 ± 10 years, 1,805 patients (64%) were women, and 207 patients (7%) were taking a DOAC prior to surgery. Despite comparable preoperative and postoperative hemoglobin levels between the groups that had a DOAC withheld and the control groups (all p > 0.05), the patients who had a DOAC withheld for 1 day were more likely to receive a postoperative blood transfusion (23.1% compared with 0%; p = 0.002). This difference in transfusion rate was not observed in other cohorts. There were no differences in medical complications, reoperation, discharge disposition, or mortality between the groups that had a DOAC withheld and the matched controls at any time point.

CONCLUSIONS: Delaying surgical management due to DOAC medications may be unnecessary in patients undergoing arthroplasty for femoral neck fractures. Consideration should be given to adjusting transfusion triggers to reduce unwarranted blood transfusions in patients taking a DOAC.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40638713 | DOI:10.2106/JBJS.24.01293

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01287. Online ahead of print.

ABSTRACT

➢ Glucagon-like peptide-1 (GLP-1) receptor agonists are a promising tool for preoperative weight loss in the patient who is undergoing orthopaedic surgery and has concomitant obesity and type-2 diabetes mellitus.➢ With regard to the perioperative management of GLP-1 receptor agonists for the orthopaedic surgeon, the American Society of Anesthesiologists (ASA) recommends withholding daily-dose GLP-1 therapy on the day of the elective surgical procedure and withholding weekly-dose therapy for the week prior to the procedure.➢ The ASA recommends postponing surgery or proceeding with "full stomach precautions" if the patient undergoing an orthopaedic procedure and taking GLP-1 therapy exhibits gastrointestinal symptoms on the day of the elective procedure.➢ In the trauma setting, patients taking GLP-1 therapy should proceed with the surgical procedure at the discretion of the surgeon with full stomach precautions or a preoperative point-of-care gastric ultrasound.➢ GLP-1 receptor agonists show the potential for disease modification in osteoarthritis and osteoporosis.

PMID:40638702 | DOI:10.2106/JBJS.24.01287

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.00098. Online ahead of print.

ABSTRACT

BACKGROUND: The diagnostic accuracy of neurological examination findings for identifying degenerative cervical myelopathy (DCM) is not apparent, given the paucity of studies with appropriate control groups. In order to address this knowledge gap, we conducted a community cervical spine screening project and examined subjects without DCM or evidence of myelopathy on cervical magnetic resonance imaging (MRI).

METHODS: This study included a total of 229 patients diagnosed with DCM, based on MRI evidence of spinal cord compression and improvement after surgery, and 807 controls without DCM (40 to 79 years of age) enrolled in the screening project. Neurological examination was performed on each subject, including the assessment of deep tendon reflexes at the biceps, triceps, patella, and Achilles tendon and the Hoffmann reflex, Babinski sign, sensory disturbance, and 10-second grip-and-release test. Multiple logistic regression analysis was performed to build a diagnostic model for DCM based on the neurological examination findings.

RESULTS: Using a stepwise multiple logistic regression analysis method, an almost perfect diagnostic model was designed that comprised sex, age, 10-second grip-and-release test, patellar tendon reflex, Hoffmann reflex, Babinski sign, and sensory disturbance (area under the curve [AUC] in the receiver operating characteristic curve analysis, 0.994). However, given that the last 2 parameters are less commonly evaluated in routine practice, an alternative reduced model was developed for practical use and consisted of sex, age, Hoffmann reflex, patellar tendon reflex, and 10-second grip-and-release test. The reduced model yielded a nearly equivalent AUC of 0.956.

CONCLUSIONS: Both diagnostic prediction models demonstrated excellent accuracy in distinguishing patients with DCM from subjects without DCM, highlighting the importance of combining specific neurological signs and performance measures when evaluating patients with suspected DCM.

LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:40638695 | DOI:10.2106/JBJS.24.00098

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01219. Online ahead of print.

ABSTRACT

BACKGROUND: Psychological distress is increasing in adolescents and young adults, but comprehensive screening programs are not commonly incorporated into orthopaedic clinical practice. We implemented a screening program for depression symptoms and psychological distress in adolescents and young adults with hip pain. The aims of this study were to report the prevalence and risk factors and determine the relationship with patient-reported pain and dysfunction.

METHODS: Patients 10 to 24 years of age presenting for hip pain at an initial clinic visit completed the Patient Health Questionnaire-9 (PHQ-9), the 17-item Optimal Screening for Prediction of Referral and Outcome-Yellow Flag (OSPRO-YF) tool, and the International Hip Outcome Tool-12 (iHOT). Two outcome levels for depression symptoms using the PHQ-9 were compared (mild or less versus moderate or greater), and 3 outcome levels for psychological distress using the OSPRO-YF were compared (none or mild versus moderate versus severe). Age, sex, body mass index, previous surgery, and the hip diagnosis were entered into logistic regression models to predict outcomes for the levels of depression symptoms and psychological distress. iHOT scores were compared between groups using the Wilcoxon rank-sum test and the Kruskal-Wallis test followed by pairwise Wilcoxon rank-sum tests.

RESULTS: Among 500 patients who completed screening, 10.6% had moderate or greater depression symptoms and 26.9% had severe psychological distress. Multivariable logistic regression revealed that young adults (age, 20 to 24 years) had higher odds of moderate or greater depression symptoms compared with adolescents (age, 10 to 19 years) (odds ratio, 2.09; p = 0.016). Female patients (risk ratio [RR], 1.86; p = 0.026), patients who had undergone a prior surgery (RR, 2.29; p = 0.025), and overweight patients (RR, 2.10; p = 0.008) had a higher risk of severe psychological distress. Both moderate or greater depression symptoms and increasing levels of psychological distress were significantly associated with lower iHOT scores (all p < 0.001).

CONCLUSIONS: Psychological distress was common in adolescents and young adults with hip pain and was associated with greater patient-reported hip pain and dysfunction. Young adults had a greater risk of depression symptoms. Severe psychological distress was more common in female patients, overweight patients, and those who had undergone failed prior hip surgery.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40638688 | DOI:10.2106/JBJS.24.01219

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01420. Online ahead of print.

ABSTRACT

➢ Strategic action following the measurement of outcomes in the context of cost allows for the reallocation of resources to value-adding interventions, while eliminating non-value-adding services.➢ Providers and administrators should leverage institutional alignment to advance best-practice principles through integration and utilization of patient-reported outcomes and cost-containment initiatives and engagement in institution-wide value-based care dialogue.➢ Health-care policy and reimbursement structures in the United States are shifting from a fee-for-service model to a value-based care model with policy changes such as the Hospital Price Transparency Regulation by the U.S. Centers for Medicare & Medicaid Services, Comprehensive Care for Joint Replacement, the risk-standardized performance measure for elective total hip arthroplasty and total knee arthroplasty based on patient-reported outcomes, and the Transforming Episode Accountability Model.➢ The incorporation of machine learning technologies presents major potential for refining our understanding of high-value events and identifying exemplary surgeons within the orthopaedic field. The successful incorporation of artificial intelligence models into practice requires investment from and alignment of several partners: health-care administrators, information technology, legal teams, providers, and patients.

PMID:40638684 | DOI:10.2106/JBJS.24.01420

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01565. Online ahead of print.

ABSTRACT

BACKGROUND: Race and ethnicity and insurance status have been identified as major contributors to disparities in health care. Several studies have analyzed racial and ethnic disparities in patients with private and government insurances, but very little is known about disparities in managed care models. Kaiser Permanente (KP) is a health-care organization (health maintenance organization, HMO) within the managed health-care system. It provides integrated care through its network of facilities and doctors, with equal access to all of its beneficiaries. Hence, the objective of this study was to determine whether there are health-care disparities in spinal fusion outcomes among patients enrolled in a managed health-care system such as Kaiser Permanente.

METHODS: Using data from the KP Spine Registry, we performed a retrospective cohort study of adults ≥18 years of age who underwent spinal fusion. The predictor was race/ethnicity (White [reference], Black, Hispanic, Asian). The primary outcome was reoperations, and the secondary outcomes were 90-day emergency department (ED) visits, 90-day readmissions, and 90-day and 1-year mortality. Multivariable Cox regression and logistic regression models were used to adjust for confounders.

RESULTS: We included 40,258 patients with spinal fusions. A lower reoperation risk was observed for Black (hazard ratio [HR] = 0.90; 95% confidence interval [CI] = 0.82 to 0.99; p = 0.038), Hispanic (HR = 0.78; 95% CI = 0.71 to 0.85; p < 0.001), and Asian (HR = 0.62; 95% CI = 0.55 to 0.71; p < 0.001) patients. Black (odds ratio [OR] = 1.25; 95% CI = 1.14 to 1.36; p < 0.001) and Hispanic (OR = 1.15; 95% CI = 1.07 to 1.25; p < 0.001) patients had a higher likelihood of an ED visit within 90 days. A higher likelihood of readmission within 90 days was also observed for Black patients (OR = 1.18; 95% CI = 1.05 to 1.32; p = 0.005). No significant differences in 90-day and 1-year mortality were observed.

CONCLUSIONS: Despite equal access to spine surgery in a managed health-care system such as Kaiser Permanente, our study showed that some disparities exist among Black and Hispanic patients. We believe that managed care networks can reduce disparities relative to other health-care delivery systems, although more work needs to be done to ensure equitable outcomes in all domains. These findings underscore the urgent need to address these disparities with further research.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40638682 | DOI:10.2106/JBJS.24.01565

Int Orthop. 2025 Jul 11. doi: 10.1007/s00264-025-06603-3. Online ahead of print.

ABSTRACT

PURPOSE: Aneurysmal bone cysts (ABCs) are bone tumours characterised by blood-filled cystic lesions. Management strategies for ABCs vary widely and lack consensus. This study aims to evaluate outcomes in 258 patients and investigate the factors affecting the recurrence rates.

METHODS: This study is a single-centre retrospective analysis of patients diagnosed with ABC between January 1990 and December 2020. Patients who were histologically diagnosed with ABC, had available pathology, radiology, and surgery records, and were followed up for at least 24 months were included. Secondary ABCs were excluded. Presenting symptoms and location, computerised tomography (CT) and magnetic resonance imaging (MRI), treatment modalities, and recurrence were investigated.

RESULTS: The mean age of the 258 ABC patients was 17.25 ± 12.37 years, 67.44% being under 18 years, and 12.40% under five years. 49.45% were female. The average follow-up duration was 47.80 ± 41.92 months. Pain was the most common presenting symptom, reported by 79.97% of patients. 5.04% were asymptomatic and diagnosed incidentally, whereas 11.63% were diagnosed following a pathological fracture. The median disease-free survival was ten months, with the average time to first recurrence being 24.22 ± 22.14 months. Recurrence was more common in patients under five years of age (34.38% vs. 19.03%, p = 0.046) and in those with pathologic fractures (40.00% vs. 18.42%, p = 0.006). Conversely, recurrence was less common when burr and/or cautery was added to curettage (31.97% vs. 11.03%, p < 0.001). Time to recurrence was significantly shorter in cases with soft tissue oedema (median 5 vs. 12 months, p = 0.010) or fluid-fluid levels (median 6 vs. 12 months, p = 0.038).

CONCLUSIONS: The study found that pathological fractures and age under five years are associated with a higher risk of recurrence in aneurysmal bone cysts. Electrocauterization and/or high-speed burring as local adjuvant therapy is associated with low recurrence rates.

PMID:40640436 | DOI:10.1007/s00264-025-06603-3

Int Orthop. 2025 Jul 11. doi: 10.1007/s00264-025-06607-z. Online ahead of print.

ABSTRACT

PURPOSE: This investigation examined return-to-sport (RTS) outcomes and performance determinants following surgical fixation of acetabular fractures in young athletes. The primary objectives were to quantify RTS rates, evaluate functional outcomes, and identify key predictors of athletic recovery.

METHODS: We conducted a retrospective analysis of 62 patients (mean age: 29.6 years) who underwent acetabular fracture fixation at a tertiary care centre. The investigation encompassed pre- and post-operative athletic participation, patient satisfaction metrics, and psychological readiness assessments. Primary outcome measures included stratified RTS rates, with functional and psychological parameters evaluated using the Copenhagen Hip and Groin Outcome Score (HAGOS) and Hip Return to Sport after Injury (Hip-RSI) scale.

RESULTS: While 82.3% of patients resumed athletic activities, 53.2% returned to their primary sport, with only 19.4% achieving pre-injury performance levels. Multivariate analysis revealed that superior articular reduction quality and elevated psychological readiness scores, as measured by the Hip-RSI, were significant predictors of successful RTS outcomes.

CONCLUSION: Despite encouraging overall RTS rates, restoration of pre-injury athletic performance remains challenging. The study highlights the critical role of both psychological preparedness and anatomical reduction quality in optimizing outcomes.

PMID:40640435 | DOI:10.1007/s00264-025-06607-z

Injury. 2025 Jul 4;56(8):112579. doi: 10.1016/j.injury.2025.112579. Online ahead of print.

NO ABSTRACT

PMID:40633323 | DOI:10.1016/j.injury.2025.112579

Int Orthop. 2025 Jul 10. doi: 10.1007/s00264-025-06609-x. Online ahead of print.

NO ABSTRACT

PMID:40634775 | DOI:10.1007/s00264-025-06609-x

Int Orthop. 2025 Jul 10. doi: 10.1007/s00264-025-06584-3. Online ahead of print.

NO ABSTRACT

PMID:40634774 | DOI:10.1007/s00264-025-06584-3

Int Orthop. 2025 Jul 10. doi: 10.1007/s00264-025-06605-1. Online ahead of print.

ABSTRACT

PURPOSE: Management of blood transfusion in the peri-operative period of joint arthroplasties is often difficult and although associated risk factors and practice trends help ease this process, for shoulder arthroplasty, these aspects have not been explored as widely as other procedures. The purposes of the current study were to identify the incidence, risk factors and trends of blood transfusion in shoulder arthroplasty patients over a 25-year period in a single, high-volume centre.

METHODS: We retrospectively reviewed all patients undergoing hemi-, total and reverse shoulder arthroplasties, including revision procedures, between 1997 and 2021. Overall rate of blood transfusion, procedure and patient related risk factors, and transfusion trends over time were evaluated.

RESULTS: A total of 3,168 patients were included in the analysis and overall rate of blood transfusion was 1.8%. Multivariate analysis revealed revision procedure (p < 0.001), prior revision (p = 0.035), regional anaesthesia (p = 0.004), history of hypertension (p = 0.043), history of myocardial infarction (p = 0.004), history of renal insufficiency (p = 0.045), and alcohol abuse (p = 0.033) were independent risk factors for transfusion. Although transfusion rates were observed to be increased after 2007, from 0.6 to 0.8 to over 2%, this trend did not demonstrate statistical significance.

CONCLUSION: Revision procedures and regional anaesthesia as well as hypertension, myocardial infarction, renal insufficiency and alcohol abuse can be regarded as independent risk factors for blood transfusion in shoulder arthroplasty. It is imperative to implement advanced blood conservation protocols for patients with these risk factors.

PMID:40634773 | DOI:10.1007/s00264-025-06605-1

Int Orthop. 2025 Jul 10. doi: 10.1007/s00264-025-06606-0. Online ahead of print.

ABSTRACT

PURPOSE: The objective was to assess whether the size of the supraspinatus tendon retraction following a degenerative full-thickness rotator cuff tear influenced the functional outcome after arthroscopic direct repair.

METHODS: A prospective comparative cohort study of 65 patients underwent arthroscopic rotator cuff repair with a follow-up of 24 months. The mean age was 60.0 years (SD, 9.2). According to the supraspinatus tendon retraction, patients were included into the shorter retraction group (≤ 20 mm; n = 32) and longer retraction group (> 20 mm; n = 33). Clinical outcomes were assessed with the Constant-Murley score and visual analogue scale for pain. Radiological evaluation included magnetic resonance imaging (MRI).

RESULTS: Postoperatively, both groups significantly improved functional and pain outcomes, with no significant differences at the final follow-up (p = 0.671). The mean time interval between the onset of patient-reported symptoms and surgery was not significantly correlated with the retraction size (r = 0.12, p = 0.066). The multivariate analysis did not show significant predictors of satisfactory functional outcome, especially the tendon retraction size (OR 1.0; 95% CI 0.9-1.1; p = 0.728).

CONCLUSION: In degenerative tears, the size of the supraspinatus tendon retraction was not correlated with the duration of the symptoms. The tendon retraction of up to 4 cm did not influence the functional outcome at 24 postoperative months, regardless of the arthroscopic repair technique of one or two rows.

PMID:40634772 | DOI:10.1007/s00264-025-06606-0

Int Orthop. 2025 Jul 10. doi: 10.1007/s00264-025-06610-4. Online ahead of print.

NO ABSTRACT

PMID:40634771 | DOI:10.1007/s00264-025-06610-4

Injury. 2025 Jul 1:112569. doi: 10.1016/j.injury.2025.112569. Online ahead of print.

ABSTRACT

INTRODUCTION: Rib fractures are associated with substantial morbidity and mortality. Ultrasound-guided erector spinae plane block (ESPB) is increasingly used to manage pain in patients with rib fractures. However, ESPBs are often performed by proceduralists with extensive experience in regional anesthesia. The purpose of this study was to determine whether nonspecialized physicians could effectively perform ESPBs in patients with rib fracture pain in the emergency department.

METHODS: In a prospective convenience sample of 19 patients who came to the emergency department with rib fractures, ESPBs were performed by resident physicians under the supervision of experienced attending physicians. Pain scores, opioid use in morphine milligram equivalents (MME) per day, forced vital capacity, and maximum inspiratory pressure (MIP) were compared before and at several time points after ESPB.

RESULTS: Pain scores were higher before ESPB (median [IQR], 7.0 [6.0-8.0]) than at any time point after the procedure (P = .018). Median (IQR) opioid usage before ESPB was 57.6 (43.5-92.6) MME/d, which was significantly reduced at 24 h after ESPB (median [IQR], 51.5 [29.5-82.9] MME/d; P = .020) and during the remainder of the patients' stay (median [IQR], 33.8 [9.6-50.7] MME/d; P = .003). Further analyses showed that MIP before ESPB (median [IQR], 27.5 [6.3-32.5] cm H2O) was significantly lower than that at 0 to 6 h (median [IQR], 40.0 [35.0-60.0] cm H2O; P = .040), 12 to 18 h (median [IQR], 49.0 [30.0-60.0] cm H2O; P = .039), and 18 to 24 h (median [IQR], 60.0 [35.0-60.0] cm H2O; P = .028) after ESPB. No complications, 30-day readmissions, adverse events, or deaths occurred.

CONCLUSION: When adequately educated and supervised by experienced physicians, nonspecialized proceduralists can safely perform the ESPB procedure in the emergency department to provide effective analgesia to patients with rib fractures. ESPBs significantly decreased pain scores, reduced opioid usage, and improved respiratory mechanics.

PMID:40628600 | DOI:10.1016/j.injury.2025.112569

Injury. 2025 Jun 27:112565. doi: 10.1016/j.injury.2025.112565. Online ahead of print.

NO ABSTRACT

PMID:40628599 | DOI:10.1016/j.injury.2025.112565

Injury. 2025 Jul 3:112582. doi: 10.1016/j.injury.2025.112582. Online ahead of print.

NO ABSTRACT

PMID:40628598 | DOI:10.1016/j.injury.2025.112582

Injury. 2025 Jul 3;56(8):112584. doi: 10.1016/j.injury.2025.112584. Online ahead of print.

NO ABSTRACT

PMID:40627998 | DOI:10.1016/j.injury.2025.112584

Injury. 2025 Jul 2;56(8):112572. doi: 10.1016/j.injury.2025.112572. Online ahead of print.

ABSTRACT

BACKGROUND: There is a plethora of literature regarding hip fracture care, including care standards, use of registry/clinical audit data for improvement, benchmarking and outcomes. There is, however, very little published information describing how to establish and govern a national hip fracture audit. To explore the availability of information about hip fracture national clinical audit (NCA) development and governance, a scoping review was conducted.

METHODS: Electronic searches of MEDLINE (Ovid), Embase (Elsevier) and CINAHL (EBSCOHost) were conducted for articles describing national hip fracture clinical audits, published in English between 1988 and 2024. Factors for establishing the governance of a national hip fracture clinical audit were extracted and reported. Findings were shared with knowledge users from the Global Fragility Fracture Network (FFN) Hip Fracture Audit Special Interest Group and the Irish Hip Fracture Database Governance Committee to ascertain their completeness and validity. Descriptive analysis was used to summarise findings.

RESULTS: Thirteen articles were eligible for inclusion, representing 60 % of the known established hip fracture NCAs. From these, 11 components for the governance of hip fracture NCAs were identified, however the level of detail varied across the included articles. At least one of these components appeared in 83 % of the included articles, suggesting substantial consistency across hip fracture NCAs. Notably, five articles provided descriptions of all 11 components.

CONCLUSIONS: Overall, there was congruency in the approach taken to establish the governance of hip fracture NCAs and therefore the components identified could be used to support existing and emerging hip fracture NCAs in their development and sustainability.

PMID:40627997 | DOI:10.1016/j.injury.2025.112572