Clinical Research Directory

Total Intravenous Versus Inhalational Anesthesia in Patients Undergoing Hip Fracture Surgery

This prospective observational study aims to compare total intravenous anesthesia (TIVA) with sevoflurane-based inhalational anesthesia in patients aged 65 years and older undergoing hip fracture surgery under general anesthesia. The study will evaluate postoperative quality of recovery using the Quality of Recovery-40 (QoR-40) questionnaire and cognitive outcomes, including postoperative delirium and cognitive status. Pain scores, opioid consumption, recovery room stay, postoperative complications, and patient satisfaction will also be recorded. The anesthesia technique will be determined by the attending anesthesiologist as part of routine clinical practice, and the researchers will not interfere with the choice of anesthesia.

PENG vs. FIC Block for Hip Fracture ED Patients

Ultrasound-guided nerve blocks are an important tool for treating pain due to orthopedic injury in the ED. They provide long lasting, opioid-sparing pain relief that is generally safe and well-tolerated by patients1. Elderly patients with hip fractures commonly present to the ED, and their injury can be painful. Commonly used opioid pain regimens can have deleterious side effects, especially in elderly patients, like somnolence, delirium, hypotension and respiratory depression. The fascia iliaca compartment (FIC) block has become a familiar technique to emergency physicians as a pain control treatment for hip fractures. The pericapsular nerve group (PENG) block has recently been proposed as a novel method to treat pain due to hip, acetabular and pelvic fracture by targeting the terminal sensory articular nerve branches of the femoral nerve (FN), obturator nerve (ON), and accessory obturator nerve (AON). At this time there has been no study comparing the efficacy of the two nerve blocks, PENG and FIC. This aim of this study is to compare the efficacy of the PENG block (20mL of Bupivacaine 0.50%) to that of the FIC block (40mL of Bupivacaine 0.25%) for patients with hip fractures in the ED. Our hypothesis is that PENG will demonstrate analgesia that is non-inferior to FIC. Subjective pain scores on a scale of 0 to 10 will be assessed before and after the block. All subjects will receive 4mg of morphine after consent and prior to the block.

Comparison of the Efficacy of Ultrasound-guided Supra-inguinal Fascia Iliaca and Lumbar Erector Spina Plan Block in Hip Fractures

The aim of our study was to evaluate the efficacy and patient satisfaction level of SI-FIB and lumbar ESPB for positioning and postoperative analgesia during spinal anesthesia in patients undergoing hip fracture surgery.

Hope Theory-Based Nursing Intervention After Hip Fracture Surgery

This is a randomized controlled trial to evaluate the effectiveness of a Snyder Hope Theory-based nursing intervention on elderly patients following hip fracture surgery. The study aims to improve the patient's psychological well-being, reduce pain, and enhance their functional recovery. Participants will be randomly assigned to either the intervention group or the control group. The intervention involves individualized counseling, goal setting, and rehabilitation training based on the Snyder Hope Theory. The trial will assess changes in hope levels, anxiety, pain, hip joint function, and quality of life before and after the intervention.

Nerve Block and Perioperative Myocardial Injury in Elderly Hip Fracture

This single-center, retrospective cohort study evaluates whether a single preoperative peripheral nerve block can reduce the risk of perioperative myocardial injury in elderly patients undergoing delayed hip fracture surgery, defined as surgery performed more than 48 hours after injury. Hip fracture is a serious and common injury in older adults worldwide. When surgery cannot be performed within the recommended 48-hour window, patients face a much higher risk of heart muscle damage (myocardial injury), which is strongly linked to increased complications and death. Peripheral nerve blocks are a standard, safe method for pain control in hip fracture care, but their potential protective effect on the heart has not been specifically studied in patients with delayed surgery. This study will review medical records of patients aged 65 years and older who received hip fracture surgery at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 1, 2019 and December 31, 2025, with time from injury to surgery longer than 48 hours. Patients who received a single peripheral nerve block before surgery will be compared with patients who did not receive any peripheral nerve block. The main measure of the study is the rate of myocardial injury during hospital stay, detected by elevated troponin levels in routine blood tests. The study will also examine new-onset myocardial injury within 72 hours after surgery, major heart-related adverse events and all-cause death within 30 days after surgery, length of hospital stay, and other common postoperative complications. Researchers will also explore whether the timing of nerve block placement and different block techniques have different heart-protective effects. The findings may provide evidence for a simple, safe and practical strategy to reduce heart complications in older hip fracture patients who cannot receive timely surgery, and help clinicians improve perioperative care for this high-risk population.

GNRI and Rectus Femoris Muscle Thickness in Older Patients Undergoing Hip Fracture Surgery

This prospective observational study will evaluate whether nutritional risk and reduced muscle mass are associated with postoperative outcomes in adults aged 65 years or older undergoing surgery for hip fracture. Nutritional risk will be assessed using the Geriatric Nutritional Risk Index (GNRI), which is calculated from routine preoperative serum albumin, body weight, and ideal body weight. Rectus femoris muscle thickness will be measured before surgery using a brief, noninvasive ultrasound examination of the non-fractured thigh. Participants will receive routine clinical care, and no treatment or anesthesia method will be assigned by the study. Clinical information will be collected from hospital records, including postoperative length of hospital stay, surgical site infection, and mortality. Survival status will be evaluated at 30 and 90 days after surgery using hospital records and/or telephone follow-up.

AI-Based Risk Factor Analysis and Prediction Model of MACE in Elderly Hip Fracture Patients Postoperatively

This is a multicenter ambispective observational cohort study led by Beijing Anzhen Hospital, Capital Medical University, with China-Japan Friendship Hospital serving as the external validation center. Major adverse cardiovascular events (MACE) occurring after surgery are common complications among older adults undergoing hip fracture surgery and are associated with poor long-term outcomes, including increased one-year mortality. Previous studies have not systematically evaluated perioperative risk factors or developed prediction models specifically for this population. In addition, conventional statistical approaches may have limited ability to account for complex interactions and nonlinear associations among multiple perioperative variables. Therefore, this study aims to identify risk factors for postoperative MACE and to develop and externally validate a machine learning-based prediction model. Patients aged 60 years or older who undergo surgical treatment for hip fracture will be included. The derivation cohort, established at Beijing Anzhen Hospital, will be used for model development and internal validation, whereas the independent external validation cohort, established at China-Japan Friendship Hospital, will be used to evaluate the generalizability and predictive performance of the developed model. The study will adopt a bidirectional cohort design: one portion of the study population will be identified retrospectively from electronic medical records, and the remaining participants will be consecutively enrolled prospectively following ethics committee approval. Postoperative outcomes will be ascertained from the end of surgery until the earliest occurrence of hospital discharge, death, or postoperative day 30. Standardized, de-identified data will be collected, including demographic characteristics, comorbidities, laboratory findings, surgical and anesthetic information, perioperative medications, and postoperative MACE outcomes. No study-specific intervention will be assigned, and all patients will receive routine clinical care. Data will be managed in accordance with institutional privacy policies and applicable data protection requirements. Candidate predictors will be evaluated using univariable analyses, least absolute shrinkage and selection operator regression, and random forest-based feature selection. Prediction models, including logistic regression, XGBoost, and LightGBM, will be developed in the derivation cohort. Internal validation will be performed using resampling methods, and external validation will be conducted using data from the independent validation center. Model performance will be assessed in terms of discrimination, calibration, and clinical utility using the area under the receiver operating characteristic curve, calibration plots, and other appropriate performance measures.

Effectiveness of the Delirium Zero Protocol to Prevent the Onset of Delirium in Patients Undergoing Hip Fracture Surgery

The main objective of this research will be to investigate whether the control of care provided by the family/caregiver can prevent the incidence of delirium in individuals undergoing surgical intervention for hip fracture. The research will be a randomized, single-blind, parallel, two-arm clinical trial that compares two conditions: intervention group, hereafter IG (Delirium Zero protocol based on a space-temporal orientation poster for the patient, a clock hung on the wall next to the orientation poster, and a checklist for the preventive measures taken by the caregiver/family), and control group, hereafter CG (standard of care). The participants will be patients over 65 years old, admitted to the trauma hospitalization units at the La Fe University and Polytechnic Hospital (La Fe Health Department, Valencia, Spain) and at the Manises Hospital (Manises Health Department, Spain), who have had hip fracture surgery and are accompanied by a family member/caregiver. The research will take place in these centers because the rooms are private, which allows there to be no interference between the intervention under study (in the IG) or the standard care (CG).

Improving Shared DECISion-making in oldEr Hip Fracture Patients Living With Frailty

Title Improving shared decision-making in older hip fracture patients living with frailty Aim To use routinely information normally collected by the NHS, and interviews with patients, families, and healthcare professionals, to produce an aid to help patients make decisions about hip fracture treatment that reflects what is important to them. Background Breaking a hip after a fall is common in older adults. The risk of dying is high after a hip fracture, especially if the person does not have surgery. Most UK patients have surgery even if they are very frail. Patients who are at a very high risk of dying still have surgery to help control the pain. However, this is not the same in all countries and recent studies show pain can be well controlled with medications and nerve-numbing drugs. Whilst the risk of dying is still much higher without surgery, to some frail older adults there are more important things to them than living longer like being able to walk and look after themselves. Some people may choose end-of-care instead of an operation if surgery means they won't be able to do these things afterwards. To help frail older people make the decision that is best for them, they need information about all treatment options and what their life is likely to be like after. This information needs to be easy to understand. Why the research is important This research will give frail older people with hip fractures the information they need to make decisions that focus on what is most important to them. We will make a guide to present the information in a way that is easy to understand and will help patients make decisions alongside healthcare professionals. Design We will complete 4 Work Packages (WPs): WP1: What do we already know about the link between frailty and the ability for older people to move and look after themselves after hip fracture? • We will review all current studies that look at what frail older peoples' lives are like after having a hip fracture and combine all the information in these studies. This will stop us from repeating work already done and show us any gaps in knowledge. WP2: Can we use how frail someone is and other information to predict their ability to move and look after themselves after a hip fracture? • We will use data the NHS collects to explore links between frailty, health and social issues, and a person's ability to move, walk, and care for themselves after hip fracture. I will see if these factors predict which people will do better after a hip fracture. WP3: What factors affect treatment decisions in frail adults with a hip fracture? • We will interview older hip fracture patient with frailty, families, and healthcare staff to explore how decisions are made about hip fractures and how we can improve this. WP4: Creating and testing an aid to help older patients with frailty make decisions about hip fracture treatment • We will work with patients to design a decision aid to improve shared decision-making in hip fracture care. We will test out the aid on orthopaedic wards in Southampton and improve it based on feedback.

Comparison of Three Analgesic Strategies for Hip Fracture Surgery

Hip fracture surgery is associated with significant postoperative pain and increased opioid requirements. Regional anesthesia techniques may improve analgesia and reduce opioid consumption. This prospective, randomized, double-blind, controlled trial aims to compare the postoperative analgesic efficacy of Quadro-Iliac Plane Block (QIPB), Suprainguinal Fascia Iliaca Block (SIFIB), and standard analgesia in patients undergoing hip fracture surgery under spinal anesthesia. The primary outcome is cumulative tramadol consumption during the first 24 postoperative hours. Secondary outcome measures include postoperative pain intensity, rescue analgesic requirement, incidence of postoperative nausea and vomiting, Quality of Recovery-15 (QoR-15) score, and patient satisfaction score.

IRONCARE: Iron Treatment in Older Patients With Hip Fractures

The aim of this study is to investigate the effects of intravenous (IV) iron therapy compared to alternate-day oral iron treatment and no supplementation in older patients with hip fractures. This study will examine the impact of iron treatment on fatigue, functional decline, fear of falling, cognitive impairment, and quality of life, as well as its effects on iron stores and hemoglobin levels, with the overall goal of improving postoperative rehabilitation. The trial will be conducted on five different hospitals in the Central Region of Denmark (Region Midtjylland).

The Effects of Intravenous Iron on Mobility in Elderly Patients Following Hip Fracture Surgery

The primary aim of this clinical trial is to investigate the effects of intravenous iron on recovery in mobility compared to the pre-fracture level in patients with a hip fracture The main questions it aims to answer are: It is hypothesize that intravenous iron will enhance gains in mobility and hereby recovery of mobility, increase hemoglobin (Hgb), lower fatigue, have a positive effect on skeletal muscles in the weeks and months after administration. The primary objective is to compare the effect of a single dose of ferric derisomaltose (FDI) (20 mg/kg body weight) relative to placebo on patients' recovery of functional mobility, measured as the change from baseline in the New Mobility Score. Participants will: \- Receive either a single dose of intravenous FDI (20 mg/kg body weight) (and saline) or placebo (saline) at 1-5 days after surgery. This trial will be conducted at three hospitals in Denmark, involving an anticipated 210 participants.

Comparison of Meta-PENG and Suprainguinal Fascia Iliaca Plane Block in Hip Fractures

This prospective observational single-center study will compare the effects of ultrasound-guided meta-PENG block and suprainguinal fascia iliaca plane block in patients undergoing hip fracture surgery under spinal anesthesia. Hip fracture surgery can cause significant pain before, during, and after the operation. Regional anesthesia techniques may help reduce pain, improve positioning for spinal anesthesia, decrease the need for additional analgesics, and support earlier mobilization. Patients included in the study will be adults scheduled for hip fracture surgery under spinal anesthesia. According to routine clinical practice and the anesthesiologist's decision, patients will receive either ultrasound-guided meta-PENG block or ultrasound-guided suprainguinal fascia iliaca plane block. The study will not assign patients to a treatment group by randomization. The main outcome will be pain during positioning for spinal anesthesia, measured using the Numeric Rating Scale. Additional outcomes will include postoperative pain at rest and during activity, additional analgesic consumption, patient satisfaction, mobilization time, and length of hospital stay.

Implementation of the MOX Activity Monitor in Hospitalized Geriatric Rehabilitation

Staying active is essential for healthy aging, but hospitalized older adults in rehabilitation often move very little. This study explores how much physical activity these patients actually get and how it relates to their recovery. Using the MOX activity monitor-a device that accurately tracks walking, standing, and sedentary time-the study aims to better understand daily activity patterns during rehabilitation. Researchers will test the best way to use the MOX monitor, develop a standard protocol for its use, and integrate its data into patients' electronic health records. By comparing MOX activity data with standard measures of physical performance, the study will determine how useful activity monitoring is for tracking recovery in older patients. This could lead to improved care and more personalized rehabilitation plans in the future.

How Bleeding Affects Delirium in Older Patients With Hip Fractures: The IMPROVE-HIP Study

The goal of this clinical trial is to investigate whether early detection of bleeding and prompt blood transfusions can help prevent delirium in patients aged 75 and older who are admitted to the hospital with hip fractures. The main question the trial aims to answer is: Do patients aged 75 and older with hip fractures benefit from earlier treatment of anemia (low blood count) to reduce the risk of delirium? Researchers will compare early diagnosis and treatment of bleeding with standard care to determine if it helps lower the risk of developing delirium. Participants will: Undergo blood tests, have their vital signs monitored, and be screened for delirium three times a day for the first 48 hours after surgery. Receive blood transfusions promptly if their hemoglobin levels fall below a specified threshold. Attend a follow-up visit at 30 days to assess cognitive function and overall quality of life. Attend another follow-up at 90 days to evaluate hospital readmissions and survival.

Fascia Iliaca vs Femoral Nerve Block in Hip Fracture Patients

Hip fractures are common orthopedic injuries, especially in older adults, and surgical repair such as hip arthroplasty is often required. Effective pain control is essential in these patients to allow proper positioning for spinal anesthesia, reduce patient discomfort, and improve overall perioperative outcomes. Two commonly used regional anesthesia techniques for pain relief in hip fracture patients are the Fascia Iliaca Compartment Block (FICB) and the Femoral Nerve Block (FNB). Both techniques aim to block pain signals from the femoral nerve and related nerves supplying the hip region. However, there is ongoing debate regarding which technique provides better analgesia during positioning for spinal anesthesia. This study is a prospective, randomized controlled trial conducted at Central Park Teaching Hospital, Lahore. A total of 80 patients scheduled for hip arthroplasty will be enrolled and randomly divided into two equal groups. Group A will receive Fascia Iliaca Compartment Block, while Group B will receive Femoral Nerve Block. All patients will subsequently undergo spinal anesthesia as part of standard surgical care. The primary objective of the study is to compare the effectiveness of FICB and FNB in reducing pain during patient positioning for spinal anesthesia. Pain will be measured using the Numeric Rating Scale (NRS), which is a standard 0-10 pain scoring system, assessed before the nerve block and during positioning for spinal anesthesia. Standard monitoring will be used in all patients, including blood pressure, pulse oximetry, and electrocardiography. Both techniques will be performed using standard local anesthetic agents. Rescue analgesia will be provided if required to ensure patient safety and comfort. Data will be analyzed using appropriate statistical methods, and pain scores will be compared between the two groups. A p-value of ≤0.05 will be considered statistically significant. The study aims to determine which regional anesthesia technique provides superior analgesia during spinal anesthesia positioning in hip fracture patients. The findings may help improve pain management strategies, enhance patient comfort, and optimize perioperative care in orthopedic surgery.

Frailty, Hip Fractures and Inflammatory Biomarkers

We ought to investigate if hip fracture patients suffering from frailty have higher inflammatory burden according to simple inflammatory biomarkers.

Effect of PENG Block on Postoperative Tramadol Consumption in Partial Hip Prosthesis Surgery

This study aims to evaluate the effect of ultrasound-guided pericapsular nerve group (PENG) block on postoperative tramadol consumption, pain scores, and clinical outcomes in patients undergoing partial hip prosthesis surgery. Patients aged 18-75 years scheduled for surgery under general anesthesia were divided into two groups: those receiving PENG block and those not receiving the block. Postoperative tramadol consumption within the first 24 hours, visual analog scale (VAS) and numeric rating scale (NRS) scores, hemodynamic parameters, additional analgesic requirements, and recovery characteristics were recorded and compared between groups. The findings of this study are expected to contribute to optimizing multimodal analgesia strategies in hip surgery.

Frailty and Nottingham Hip Fracture Score for Predicting 90-Day Mortality After Hip Fracture Surgery

Hip fractures are serious injuries that occur mostly in older adults. Many people experience health problems or may die in the months after surgery. Doctors try to identify patients who have a higher risk of poor outcomes as early as possible. Doctors often use the Nottingham Hip Fracture Score (NHFS) to estimate the risk of death after hip fracture surgery. This score uses information such as age and other health conditions. However, it does not fully reflect how physically vulnerable a person may be. Another important concept is frailty. Frailty describes how strong or weak a person's overall health and physical reserve are. In this study, frailty will be measured using the Clinical Frailty Scale (CFS). This scale evaluates a person's level of independence and physical function before the fracture. The purpose of this study is to determine whether measuring frailty can improve the prediction of death after hip fracture surgery. Older adults with hip fractures who undergo surgery will be invited to participate in the study. Researchers plan to include about 200 participants or all eligible patients enrolled within one year, whichever occurs first. Health information that is already collected during routine hospital care will be recorded. Frailty will be assessed when participants are admitted to the hospital. Participants will be followed for 30 days and 90 days after surgery to determine survival status. Researchers will review hospital records and may contact participants or their relatives by phone if needed. The results of this study may help doctors better identify patients at higher risk and improve care planning after hip fracture surgery.

The Hip Fracture Surgical Approach Trial

The HIFSAT study will compare the standard direct lateral approach to hemiarthroplasty to a new muscle sparing approach (SPAIRE) in femoral neck fracture patients.

Communication for Early Mobilisation of People Living With Dementia Following Surgery for Hip Fracture

This goal of this study is to identify ways that healthcare professionals communicate that are effective in helping a person living with dementia to stand or walk after surgery for a broken hip (hip fracture). We aim to identify 'what works' in successfully helping people with dementia to mobilise early, and share this in practice. The main question the research aims to answer is: What healthcare professional communication practices are effective in achieving early and continued mobilisation among people living with dementia following hip fracture surgery? We will use a research method called 'Conversation Analysis', to look at the fine detail of the language healthcare professionals use and responses to it. We will make video recordings of real-life ward care, when healthcare staff are trying to help a person with dementia get up early after hip fracture surgery. We will involve people with dementia in decisions to take part and get agreement from their families before we record anything. We have done this successfully in two previous studies. We will record up to 50 episodes of care on three trauma orthopaedic wards. We will identify specific, practical recommendations and 'teachable' approaches: ways of speaking, or sequences of requests or instructions. We will work with people with dementia, family carers, educators and clinicians to do this. We will use clips of videos in future communication training.

Clinical Efficacy of Exoskeleton Robot-Assisted Rehabilitation on Lower Limb Functional Recovery in Elderly Patients With Hip Fracture

With the intensification of population aging, hip fracture, as a common bone disease, is seeing an increasing incidence rate among the elderly population. Traditional rehabilitation training methods can no longer fully meet the functional recovery needs of elderly patients with hip fractures. Due to their wearability and intelligence, exoskeleton robots provide an innovative solution for rehabilitation training. This study aims to explore the application effects of exoskeleton robots in postoperative rehabilitation for elderly patients with hip fractures by utilizing exoskeleton robot-assisted rehabilitation training for elderly hip surgery patients. The focus is on its improvements in motor ability, balance ability, and pain levels, while also assessing its impact on patients' overall quality of life and the prevention of complications.

Prediction of Mortality and Morbidity After Hip Fracture Using Monocyte Distribution Width (MDW)

Hip fracture is a common injury in older adults and is often associated with serious complications, longer hospital stays, and increased risk of death. One of the most important causes of poor outcomes after hip fracture surgery is infection, including severe infections such as sepsis. Early identification of patients at higher risk for complications could help improve treatment and survival. This study aims to examine whether a blood test parameter called Monocyte Distribution Width (MDW), along with other commonly used inflammatory markers, can help predict complications and survival in elderly patients with hip fracture. MDW is measured as part of a routine complete blood count and has shown promise in the early detection of infection and systemic inflammation. Approximately 100 patients aged 65 years or older who are admitted to the hospital with a low-energy hip fracture will be included in this study. Blood tests will be performed at hospital admission, after surgery, and at other time points as part of standard clinical care. These tests include routine blood counts and inflammatory markers such as C-reactive protein (CRP), procalcitonin (PCT), antithrombin III, and MDW. No additional invasive procedures are required beyond standard medical care. Researchers will collect information about each patient's medical history, overall health status, and daily activity level before the fracture. Patients will be followed after surgery to assess complications, length of hospital stay, and survival at 1 month, 3 months, and 1 year. The results of this study may help determine whether MDW can be used as a simple and reliable marker to identify patients at higher risk of complications or death after hip fracture. This could support earlier intervention, closer monitoring, and improved care for elderly patients with hip fractures in the future.

External Validation of Ten Prediction Models for 30-day Mortality Following Hip Fracture

This study aims to externally validate ten existing prediction models with a low risk of bias for 30-day mortality following hip fracture. Data will be collected from the Dutch Hip Fracture Audit (DHFA) and supplemented with structured and unstructured data extracted through text mining using CTcue. Approximately 35 clinical variables will be used, including factors consistently associated with short-term mortality. The primary outcome is all-cause mortality within 30 days after hip fracture. Predictive performance will be assessed through discrimination (AUC), explained variance (R²), and calibration analysis. Clinical usefulness will be evaluated using Net Benefit and Decision Curve Analysis. This study seeks to identify models with strong predictive performance and practical applicability to support shared decision-making between clinicians and patients.