Current practice and barriers in fragility hip fracture management: insights from a national survey of Thai orthopaedic surgeons

Abstract

BACKGROUND: Despite well-established recommendations for the treatment and secondary prevention of fragility fractures, implementation remains challenging. Understanding local practice realities and barriers is therefore essential for adapting global guidelines to national health systems. This study assessed the management of fragility hip fractures in elderly patients in Thailand, focusing on the perspectives of orthopaedic surgeons. METHOD: We conducted a questionnaire-based survey of orthopaedic surgeons in Thailand who are actively involved in the care of patients with fragility fractures, focusing on acute management, secondary prevention, and overall perceptions of care. The survey was adapted and translated from the "Survey of Awareness and Attitudes to the Management of Fragility Fractures" developed by the Asia Pacific Orthopaedic Association. It was piloted with 10 volunteer orthopaedic surgeons and refined for clarity, comprehensiveness, and validity. The final questionnaire was distributed online in collaboration with the Royal College of Orthopaedic Surgeons of Thailand using registered membership contacts. RESULTS: Of 223 responses, 199 were eligible. Most participants practiced in tertiary public hospitals (36.2%), had < 5 years of experience, and managed 0-5 cases weekly. According to respondents, hip fracture fast-track protocols were available in 79.4% of hospitals, and 58.8% had fracture liaison services. Only 22.6% of respondents reported achieving surgery within 48 h in > 90% of their patients, and 46.7% prescribed osteoporosis treatment to ≥ 75% of patients. University-affiliated hospitals were more likely to prescribe osteoporosis medication (OR 4.68, 95% CI 1.87-11.67), while cost concerns reduced prescribing (OR 0.40, 95% CI 0.20-0.81). Private hospitals had the highest odds of surgery within 48 h (OR 104.43, 95% CI 7.21-1513.05). Implant unavailability was the main barrier to expedited surgery (OR 0.20, 95% CI 0.04-0.91). CONCLUSIONS: Although hip fracture fast-track protocols and fracture liaison services are increasingly available, timely surgery and osteoporosis treatment remain suboptimal. Addressing cost barriers, improving implant logistics, and expanding diagnostic access are essential to strengthen fragility fracture care in Thailand.