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The Fragility Fracture Network is coordinating international initiatives to promote collaborative research, multidisciplinary care, and the secondary prevention of fragility fractures. This review discusses the use of national audit processes and the collection of common outcomes to facilitate research, as well as the key role played by patient and public involvement, and strategies to overcome research barriers.

Highlights • The WHiTE study combines patient- and hospital-reported outcomes for 8673 participants up to four months post-surgery for hip fracture. • Following hip fracture, the most common general and surgery-related complications were chest and wound infections, respectively. • The rates of complications reported provide a reference range against which future studies might be assessed., Introduction Hip fractures are common in people over 60 years of age, and are associated with significant disability, morbidity and mortality. The aim of this study was to record the incidence of complications in the first 120 days following hip fracture. Methods The World Hip Trauma Evaluation (WHiTE) study is a multicentre, prospective cohort study conducted in National Health Service (NHS) hospitals in England and Wales. Participants are 60 years and older who received operative treatment for a hip fracture. We report the incidence of complications recorded by hospital staff until discharge from hospital and by participants at 120-days post-surgery. Results An analysis of 8673 consecutive participants enrolled in the WHiTE study revealed the following risks of complications within the first 120 days: signs of wound infection (3.1%); dislocation (0.5%); failure of fixation (0.6%); peri‑prosthetic fracture (0.3%); overall revision surgery (0.9%); blood loss requiring transfusion (6.1%); chest infection (6.3%); urinary tract infection (5.0%); deep vein thrombosis/pulmonary embolus (1.8%); cerebrovascular accident (0.6%); acute coronary syndrome/myocardial infarction (0.6%); acute kidney injury (1.3%). Conclusion The rates of complications reported here provide a reference range against which future studies might be assessed. Registration: ISRCTN63982700

Aims To assess current national practice in the management of severe open tibial fractures against national standards, using data collected by the Trauma and Audit Research Network. Materials and methods Demographic, injury-specific, and outcome data were obtained for all grade IIIB/C fractures admitted to Major Trauma Centres in England from October 2014 to January 2016. Results Data was available for 646 patients with recorded grade IIIB/C fractures. The male to female ratio was 2.3:1, mean age 47 years. 77% received antibiotics within 3 h of admission, 82% were debrided within 24 h. Soft tissue coverage was achieved within 72 h of admission in 71%. The amputation rate was 8.7%. 4.3% of patients required further theatre visits for infection during the index admission. The timing of antibiotics and surgery could not be correlated with returns to theatre for early infection. There were significant differences in the management and outcomes of patients aged 65 and over, with an increase in mortality and amputation rates. Conclusions Good outcomes are reported from the management of IIIB/C fractures in Major Trauma Centres in England. Overall compliance with national standards is particularly poor in the elderly. Compliance did not appear to affect rates of returning to theatre or early infection. Appropriately applied patient reported outcome measures are needed to enhance the evidence-base for management of these injuries.

The ageing of society is driving an enormous increase in fragility fracture incidence and imposing a massive burden on patients, their families, health systems and societies globally. Disrupting the status quo has therefore become an obligation and a necessity. Initiated by the Fragility Fracture Network (FFN) at a "Presidents' Roundtable" during the 5th FFN Global Congress in 2016 several leading organisations agreed that a global multidisciplinary and multiprofessional collaboration, resulting in a Global Call to Action (CtA), would be the right step forward to improve the care of people presenting with fragility fractures. So far global and regional organisations in geriatrics/internal medicine, orthopaedics, osteoporosis/metabolic bone disease, rehabilitation and rheumatology were contacted as well as national organisations in five highly populated countries (Brazil, China, India, Japan and the United States), resulting in 81societies endorsing the CtA. We call for implementation of a systematic approach to fragility fracture care with the goal of restoring function and preventing subsequent fractures without further delay. There is an urgent need to improve: To address this fragility fracture crisis, the undersigned organisations pledge to intensify their efforts to improve the current management of all fragility fractures, prevent subsequent fractures, and strive to restore functional abilities and quality of life.

Platelet-rich plasma has been shown in several in vitro and animal studies to play a role in promoting new bone formation. A systematic literature review was conducted to identify the current relevant evidence base, searching across multiple sources including Medline, Embase and the Cochrane Library, and finding five clinically relevant articles. Only one was a randomised controlled trial, but this was underpowered for the outcome measure defined. Three studies exclusively concerned children, and included those with congenital limb deformities. Two other reports were case series. Early clinical results suggest that the use of platelet-rich plasma is safe and feasible, but that at present there is no clinical evidence of benefit in either acute or delayed fracture healing.

Summary Background Non-union following long bone fractures is a cause of significant morbidity to the patient. The management of this condition has proved difficult for the orthopaedic surgeon. Much research has been carried out on the use of electromagnetic stimulation in the healing of non-union. Objectives The objective of this review is to determine what evidence exists to support electromagnetic stimulation in the management of established non-union of long bone fractures. Methods A systematic search was carried out of the peer-reviewed English language literature to identify all studies investigating electromagnetic stimulation in the treatment of non-union of fractures of long bones. Results Three of the articles reviewed were randomised clinical trials. Forty-six other studies were also included in the review. Conclusions There is a consensus that electromagnetic stimulation is an effective adjunct to conventional therapy when used in the management of non-union of long bone fractures.

Classification systems for fractures of the femur with a prosthetic hip in situ are diverse and complex. Most of them are based on the site of the fracture, which is not the most important differentiating factor in treatment planning. The Coventry classification system groups the periprosthetic fractures into 'happy hips' and 'unhappy hips' based on whether or not the stem is loose. In 'happy' hips, treatment only needs to address the fracture itself, unless the fixation has been compromised by the fracture. In the 'unhappy hips', revision of the prosthesis is recommended.

Recent experimental and clinical evidence suggests that early loading and mobilisation for Achilles tendon ruptures may improve functional outcomes. This paper presents the results of a pilot study designed to assess the safety of immediate weight-bearing mobilisation. Twenty-eight operatively repaired patients were randomised to either immediate loading in an orthosis or traditional serial plaster casting. An independent observer, blinded to treatment, assessed the results. Improved clinical, anthropometric, and functional outcomes were noted in the immediate loading group. Ultrasound assessment confirmed no deleterious effects upon the tenodesis. There was one re-rupture of the tendon at a minimum follow-up of 1 year.