Open research questions in Hip and Femur Fractures

What the literature leaves open

• Block implementation varied widely between hospitals across the Netherlands. The observed difference in mortality between the block and non-block groups, and its reversal after 30 days, warrants closer examination.

  Use of neurolytic nerve blocks and mortality in nonoperative management of hip fracture patients · 2026 · DOI

• Because FRAX variables and other established clinical risk factors were not consistently available, the incremental value of pelvic muscle quality beyond standard fracture-risk Page 11 of 13 118 predictors could not be assessed.

  Cloud-Enabled Automated CT Assessment of Pelvic Muscle Quality in Women With and Without Low-Energy Femoral Neck Fracture · 2026 · DOI

• INTRODUCTION: The area deprivation index (ADI) is a valuable tool for assessing patient risk holistically, yet there is limited research on the link between area deprivation and patient-reported outcomes in adult orthopaedic trauma patients after surgery.

  Increased Social Deprivation Correlates With Worse Postoperative Pain and Anxiety PROMIS Scores in Distal Femur Fractures · 2026 · DOI

• However, its potential benefits over the conventional posterolateral approach (PLA) in reducing blood loss and improving short-term function remain unclear.

  A minimally invasive transpiriformis approach versus the conventional posterolateral approach in total hip arthroplasty for elderly femoral neck fractures: perioperative blood loss and early functional recovery · 2026 · DOI

• BACKGROUND The correlation between psychological status and pain, comfort, and postoperative recovery in patients with femoral neck fracture (FNF) has rarely been examined, yet its potential influence on recovery cannot be overlooked.

  Psychological status in femoral neck fractures: Effects on pain, comfort, and postoperative recovery · 2026 · DOI

• Period of implementation Short-term Medium-term Long-term Development of training and educational programmes for TBS in fracture care (treatment of open fractures, infection control, bandaging and splinting, general anatomy) with appropriate certification Develop evidence-based guidelines that specify cross-sectoral referrals between biomedical and TBS care. This includes guidance for TBS on the referral of complex fractures Political commitment and support from the Ministry of Health on integrating biomedical and traditional care into secondary- and tertiary-levels of the health system Workshops to facilitate intersectoral dialogue and communication between health system actors (policymakers, healthcare professionals, facility managers, researchers) and TBS Establish regulatory mechanism for TBS practices, including establishing quality control measures, licensing requirements and a TBS registry Co-designing of collaborative initiatives which involve community members, TBS, and health system actors (including policymakers, healthcare professionals, facility managers, researchers) Remove geographical barriers to accessing biomedical care by improving road conditions and networks for better transportation access (including ambulance access) Implement community-based educational campaigns for the biomedical treatment of hip fractures Continued research to strengthen the evidence base for integration of traditional and biomedical sectors of care https://doi.org/10.1371/journal.pgph.0006582.t003 high out-of-pocket health expenditure and insufficient human resources. As noted above, our work identified that less than one orthopaedic surgeon is currently available for each 100,000 adults in The Gambia, with only around 7% of current inpatient care dedicated to orthopaedics. Given this, healthcare professionals emphasised the futility of collaborative initiatives if existing barriers to orthopaedic care are not addressed. Recommendations for research, policy, and practice Considering our analysis and the key objectives from the WHO’s newly published Traditional Medicine Strategy (2025– 2035), Table 3 outlines recommendations that could be implemented in the short-, medium-, and longer-term to support collaboration between traditional and biomedical sectors on the provision of hip fracture care in The Gambia. These recommendations were derived from suggestions made by healthcare professionals and TBS during the interviews, framed within the WHO Traditional Medicine Strategy objectives. As described above, the Strategy outlines four strategic objectives including the need to strengthen the evidence base around the safety and effectiveness of biomedical, traditional, and complimentary care, establishing regulatory mechanisms, integrating traditional and complimentary medicine into health systems, and supporting the empowerment of communities to make informed care decisions about their treatment.

  Traditional bone setter practices and the interaction with biomedical care in the treatment of hip fractures in The Gambia: A qualitative study · 2026 · DOI

• As majority of TBS did not charge a standard fee, their income from exclu- sively practicing bone setting was insufficient and the TBS interviewed had a range of primary occupations.

  Traditional bone setter practices and the interaction with biomedical care in the treatment of hip fractures in The Gambia: A qualitative study · 2026 · DOI

• Given that several TBS thought that biomedical healthcare professionals were seen as having a higher status within the healthcare system than TBS, TBS participants may have emphasised successful treatment outcomes or underreported complications.

  Traditional bone setter practices and the interaction with biomedical care in the treatment of hip fractures in The Gambia: A qualitative study · 2026 · DOI

• AIMS: Femoral neck fractures require total hip arthroplasty for treatment; however, the efficacy comparison between the Moore approach and the SuperPATH approach remains unclear.

  Comparison of SuperPATH Approach and Moore Approach for Total Hip Arthroplasty in Patients With Femoral Neck Fractures: A Retrospective Study · 2026 · DOI

• POPFF management and care are under-researched (1), resulting in 513 critical gaps in knowledge to inform service design and good quality guidance. Research in these areas is warranted to inform such guidance so that it 533 is sensitive to contextual factors driving variation in services.

  Expert perspectives on improving services for patients with periprosthetic femoral fractures: a qualitative study · 2026 · DOI

• THA has obvious limitations in long-term efficacy for young patients: literature reports show that the twenty-year prosthesis survival rate is only 41%-66% for patients under thirty-five years old who undergo initial THA, and clinical evidence for initial THA in young patients with hip fractures is insufficient.

  Treatment of Pipkin Type-III Femoral Head Fractures in Young and Middle-Aged Adults with Deep Circumflex Iliac Vascular Pedicled Iliac Bone Flap Transplantation · 2026 · DOI

• While the Rommens classification comprehensively categorizes FFP, the injury mechanism—particularly in type IIIa FFP, which involves an externally rotated iliac wing fracture and a pubic rami fracture—remains unclear.

  Hip position may be associated with susceptibility to Rommens type IIIa fragility fractures of the pelvis during lateral falls: a quantitative computed tomography-based finite element analysis · 2026 · DOI

• The causes of these discrepancies remain unknown; however, possible factors may include insufficient statistical power due to stratification by various fracture sites, decline in cognitive function due to aging, low levels of health consciousness related to smoking and obesity, and lack of understanding due to low education levels. Although multisite fractures and multiple fractures have rarely been investigated in previous studies, they are considered important14).

  Validation of self-reported fractures in a follow-up survey of the Japan Multi-Institutional Collaborative Cohort study · 2026 · DOI

• Abstract Purpose of Review While social determinants of health are known to contribute to disparities in orthopaedic care, associations between social deprivation and total joint arthroplasty (TJA) outcomes remain unclear.

  Social Deprivation as a Driver of Disparities in Arthroplasty: A Contemporary Review · 2026 · DOI

• While citation count is a useful metric of academic influence, it is not without limitations. Older articles inherently benefit from longer exposure time, potentially biasing rankings in favor of historical publications. Furthermore, highly cited articles are often referenced as canonical sources, even when newer evidence exists. The exclusive use of the Web of Science database could be also considered as a limit. No citation database is exhaustive. Other sources such as Scopus, PubMed, or Google Scholar may yield different citation counts or rankings because of differences in journal coverage, indexing policies, and inclusion of non-peer-reviewed material. However, Web of Science Core Collection was selected because it is one of the most widely used databases for bibliometric analyses and provides standardized citation indexing, reliable citation tracking, and consistent export of citation metadata. It also offers high-quality citation links and broad coverage of peer-reviewed journals, making it a robust tool for reproducible citation analysis, suitable for bibliometric studies, and used among numerous previous citation analyses.

  The 100 most cited articles on acetabular fractures: an essential reading material · 2026 · DOI

• Baseline data lacked parameters such as comorbidity burden, pre-injury mobility, and body mass index (BMI), which may affect the outcomes. Objective radiographic indicators including tip-apex distance (TAD) and anteversion angle were not measured or compared, although they are critical for evaluating internal fixation stability. Owing to the limited scale of the local hospital, the sample size was relatively small. Large-sample, multicenter, prospective studies are required to further verify the long-term efficacy of this technique.

  Application value of auxiliary anterolateral hip mini-incision combined with traction-free reduction and internal fixation in complex intertrochanteric fractures in older adult patients · 2026 · DOI

• after operative fracture treatment— fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole. International 1507–1512. 41(8), Orthopaedics, https://doi.org/10.1007/s00264-017- 3481-7 Chang, X., Xu, S., & Zhang, H. (2022).

  EXPLORING FACTORS ASSOCIATED WITH ADHERENCE TO WEIGHT-BEARING EXERCISE AMONG POSTOPERATIVE LOWER LIMB FRACTURE PATIENTS · 2026 · DOI

• in ligament neurological status TLICS improves treatmentoriented assessment but depends heavily on MRI CT has high sensitivity for fracture morphology and cortical bone visualization CT identifies vertebral wall compromise and instability markers CT superior to radiography in fracture detection CT underestimated occult PLC injury and instability compared with MRI MRI improved assessment and of posterior soft-tissue injury MRI for valuable diagnosing PLC disruption spinal cord and occult injury MRI classification management cases MRI increases diagnostic confidence in acute spinal trauma MRI differentiates acute traumatic from chronic vertebral…

  COMPARATIVE DIAGNOSTIC VALUE OF CT AND MRI IN TRAUMATIC VERTEBRAL COMPRESSION FRACTURES · 2026 · DOI

• Although our finite ele- ment analysis indicates that distal placement of the screw does not necessarily increase stress concentration in the subtrochanteric region, this conclusion is based on a sim- plified model that does not account for all biological and mechanical variables present in vivo.

  Does the distal screw location in the Biplane double-supported screw fixation technique affect the risk of subtrochanteric fractures after femoral neck fixation? A finite element analysis · 2026 · DOI

• Despite the valuable insights provided by this study, sev- eral limitations must be acknowledged.First, the finite element models were based on a single artificial femur and did not account for individual variability in bone mineral density or geometry. The periarticular soft tis- sues were simplified, and the loading conditions were idealized, which may not fully represent in vivo biome- chanics. Additionally, the threaded portions of the screws were modeled as smooth cylinders to avoid stress sin- gularities and reduce computational complexity. While this approach is widely used, it may affect local stress transfer, particularly in the calcar region where thread engagement plays a crucial role.Second, the study design involved a limited sample size (n = 3), lacked fatigue test- ing under cyclic loading, and did not incorporate multi- parametric or patient-specific coupling analyses.Third, screw positions (Models a–c) were defined relative to a feasible insertion range rather than fixed bony land- marks. Although this method accommodates anatomical variability, it may reduce intraoperative reproducibility. Future studies incorporating measurements from land- marks such as the greater trochanter (LT) could improve surgical applicability and standardization. Wang et al. BMC Musculoskeletal Disorders (2026) 27:402 Page 10 of 12 Fig. 7 (See legend on next page.) Wang et al. BMC Musculoskeletal Disorders (2026) 27:402 Page 11 of 12 (See figure on previous page.) Fig. 7 (a) Medial and lateral stress distribution in the subtrochanteric region of the femur in Model a; (b) Medial and lateral stress distribution in the sub- trochanteric region of the femur in Model b; (c) Medial and lateral stress distribution in the subtrochanteric region of the femur in Model c; (d) Bar graph of medial stress in the subtrochanteric region across the three models, with no statistically significant differences observed; (e) Bar graph of lateral stress in the subtrochanteric region across the three models, with no statistically significant differences observed. One-way ANOVA were used to compare the data, p > 0.05 Table 4 Parameters Results Stress with Inner side of the subtrochanteric region (MPa) Stress with outside side of the subtrochanteric region (MPa) a model b model c model a model b model c model 1 25.522 25.374 25.006 16.253 16.242 16.152 2 26.852 26.861 26.555 16.212 16.112 16.264 3 25.685 25.661 25.689 15.784 16.03 15.778 4 25.17 25.092 24.982 15.488 15.453 15.374 5 23.905 23.786 23.851 14.335 14.589 14.546 6 23.216 23.333 23.241 13.219 13.083 13.122 7 21.483 21.494 21.428 11.85 11.797 11.368 To address these limitations, future research should proceed along two complementary directions. From a basic research perspective, it is essential to develop a comprehensive finite element model library that incorpo- rates bone density gradients, anatomical variability, and more realistic soft tissue structures. Validation through cadaveric biomechanical testing will further strengthen the credibility of the computational findings. From a clin- ical standpoint, multicenter randomized controlled trials (RCTs) should be conducted to evaluate long-term out- comes. Moreover, integrating artificial intelligence into preoperative planning, establishing standardized surgical protocols, and developing patient-specific surgical guides tailored to the BDSF technique will facilitate clinical translation and broader application.

  Does the distal screw location in the Biplane double-supported screw fixation technique affect the risk of subtrochanteric fractures after femoral neck fixation? A finite element analysis · 2026 · DOI

• Future work will focus on three key areas: (1) deep integration of the system into clinical decision workflows to maximize stability and utility across diverse healthcare environments; (2) investigation of uncertainty quantification and active-learning strategies to further improve model performance; and (3) development of multimodal fusion models that combine imaging data with electronic medical records to emulate the comprehensive judgment of clinical doctors.

  Development and validation of a deep learning-based automatic detection and classification model for femoral neck fractures using hip imaging: a retrospective multicenter diagnostic study · 2026 · DOI

• The paper proposes adapting the LightGBM fusion model methodology to other surgical contexts (orthopedic, cardiovascular) but does not specify which imaging modalities, clinical features, or hyperparameter adjustment strategies are necessary for specific pathologies; systematic guidelines for feature re-selection and model retraining protocols for domain adaptation across different surgical outcomes must be developed.

  Application of deep learning-clinical baseline feature fusion model to predict postoperative mortality in elderly patients with hip fracture: a multicenter study · 2026 · DOI

• External validation of the LightGBM-DenseNet161 fusion model was performed at only two institutions; multi-institutional validation across geographically diverse healthcare systems with different PACS configurations, imaging protocols, and patient demographics is required to assess whether the model maintains performance generalizability and to identify sources of variability in data formats across settings.

  Application of deep learning-clinical baseline feature fusion model to predict postoperative mortality in elderly patients with hip fracture: a multicenter study · 2026 · DOI

• The paper identifies that deploying the DenseNet161 deep learning component requires GPU computational infrastructure, creating barriers for resource-limited hospitals; specific technical specifications for GPU requirements, cloud-based deployment optimization, and edge computing feasibility studies for the fusion model need to be defined to support practical implementation across varied healthcare systems.

  Application of deep learning-clinical baseline feature fusion model to predict postoperative mortality in elderly patients with hip fracture: a multicenter study · 2026 · DOI

• The LightGBM fusion model relied exclusively on chest CT imaging and two clinical features (age, ASA score) for the elderly hip fracture cohort; systematic investigation of alternative imaging modalities and additional quantifiable preoperative biomarkers (laboratory values, vital sign trajectories) should be conducted to determine whether they improve predictive performance beyond the current feature set.

  Application of deep learning-clinical baseline feature fusion model to predict postoperative mortality in elderly patients with hip fracture: a multicenter study · 2026 · DOI

Most-cited papers in Hip and Femur Fractures

• Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis · Canadian Medical Association Journal · 2010 · 793 citations
• Medical Complications and Outcomes After Hip Fracture Repair · Archives of Internal Medicine · 2002 · 306 citations
• Early Ambulation After Hip Fracture · Archives of Internal Medicine · 2006 · 242 citations
• Association of Injurious Falls With Disability Outcomes and Nursing Home Admissions in Community-Living Older Persons · American Journal of Epidemiology · 2013 · 241 citations
• Incidence of fractures in a geographically defined population. · Journal of Epidemiology & Community Health · 1990 · 220 citations
• Anaemia impedes functional mobility after hip fracture surgery · Age and Ageing · 2008 · 210 citations
• The incidence of fractures among the adult population of Germany · Deutsches Ärzteblatt international · 2021 · 141 citations
• Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial · Canadian Medical Association Journal · 2008 · 130 citations
• Loss of skeletal muscle mass can be predicted by sarcopenia and reflects poor functional recovery at one year after surgery for geriatric hip fractures · Injury · 2021 · 115 citations
• Prognosis of nonoperative treatment in elderly patients with a hip fracture: A systematic review and meta-analysis · Injury · 2020 · 101 citations

Most recent work

• Re‐Examining Sedative and Hypnotic Prescribing Following Hip Fracture · Journal of the American Geriatrics Society · 2026
• Adoption of Hip Fracture Care Standards: A Mixed‐Methods Analysis of Patient and Healthcare Provider Perspectives · Australasian Journal on Ageing · 2026
• Denosumab Injection Combined with Intramedullary Nail Fixation for Osteoporotic Fractures · Indian Journal of Orthopaedics · 2026
• Comparative mid-term outcomes of hemiarthroplasty and internal fixation in treating senile femoral intertrochanteric fractures: a retrospective cohort study · Frontiers in Medicine · 2026
• Does the distal screw location in the Biplane double-supported screw fixation technique affect the risk of subtrochanteric fractures after femoral neck fixation? A finite element analysis · BMC Musculoskeletal Disorders · 2026
• Application of deep learning-clinical baseline feature fusion model to predict postoperative mortality in elderly patients with hip fracture: a multicenter study · Frontiers in Medicine · 2026
• Functional and Radiological Outcomes of Ipsilateral Femoral Neck and Shaft Fractures Treated with Proximal Femoral Nail Antirotation-2 · Annals of African Medicine · 2026
• Development and validation of a deep learning-based automatic detection and classification model for femoral neck fractures using hip imaging: a retrospective multicenter diagnostic study · Frontiers in Medicine · 2026
• From bench to bedside: a novel suture-augmented prosthesis for greater trochanteric fixation in osteoporotic hip arthroplasty · Journal of Orthopaedics and Traumatology · 2026
• Optimal position of intramedullary nails in the femoral head following spiral blade resection for revision of intertrochanteric fractures: a biomechanical analysis · Journal of Orthopaedic Surgery and Research · 2026

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