Open research questions in Hip and Femur Fractures
512 gap statements mined from Hip and Femur Fractures papers in our 7.9M-paper local library, which holds 2,078 papers on the topic — drawn mostly from each paper's own stated research gap, future-work, challenge and limitation notes, and its abstract. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one.
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What the literature leaves open
Lack of standardised prompts within the electronic documentation system. Underrecognition of NAFFs within routine clinical practice.
Implementing an identification tool to accurately capture non-ambulatory fragility fractures: a quality improvement project · 2026 · DOIA multicentre randomised trial with concealed allocation is required. Randomisation should be stratified by age, fracture displacement, Garden classification and Pauwels classification, with anatomical fracture level and reduction quality recorded prospectively and reduction quality assessed independently.
Robot-assisted versus freehand cannulated-screw fixation for femoral neck fractures: a systematic review of technical, clinical and adoption outcomes · 2026 · DOISecond, the COVID-19 pandemic caused acute disruption to HF presentations in early 2020, followed by gradual recovery through 2021–2022, with evidence of rising incidence now in both men and women in the most recent data; whether this represents a sustained trend reversal or transient recovery from pandemic-related suppression remains to be seen given the limited post-pandemic observation period.
A decade of increasing complexity in patients sustaining a hip fracture in England, Wales and Northern Ireland: a national cohort study using the National Hip Fracture Database dataset · 2026 · DOIAlthough it is well established that early surgery confers morbidity and mortality benefits for elderly patients who sustain hip fractures, only a few studies have shown a similar relationship for distal femur fractures. One contributing factor to the mixed results could be the lack of a standardized definition for delay in surgery > 48 h.
Distal femur fractures in the elderly: Does surgical delay affect morbidity and mortality? · 2026 · DOIFuture research should address whether modifications in implant selection or surgical technique can reduce dislocation rates. A formal assessment of intra-observer reliability was not performed, which represents a methodological limitation of this study.
Several limitations of this study should be acknowledged when interpreting the results. However, given the non-randomized design of this study with only 13 death events at 2 years and the potential for residual confounding by unmeasured factors, the statistical power is insufficient for any meaningful adjusted survival analysis and this finding should be interpreted with caution.
Clinical outcomes of PFNA vs. long-stem hemiarthroplasty for unstable proximal femur fractures in older adults: a retrospective cohort study · 2026 · DOIAlthough the FNS has shown promising results in younger populations—particularly in terms of union and reduced femoral neck shortening—its benefit in older adults remains uncertain.
Time to surgery and preoperative posterior tilt predict reoperation after femoral neck system fixation in older adults with nondisplaced femoral neck fractures: a retrospective cohort study · 2026 · DOIStatistically significant differences were also observed in femoral-neck postoperative day-1 pain, HHS values, and shortening; however, the absolute differences in HHS and femoral-neck shortening were small, and their clinical relevance remains uncertain.
Clinical outcomes and learning curve of robot-assisted percutaneous cannulated screw fixation for femoral neck fractures · 2026 · DOIIn addition, we did not formally quantify the incremental prognostic value of P-selectin beyond routine clinical and laboratory predictors, and this remains to be addressed in future prospective, externally validated studies. P-selectin and platelet-monocyte inflammation: mechanisms, hypothesis, and open questions.
Association of serum selectins with outcomes in older adults following hip fracture surgery: a 3-year follow-up study · 2026 · DOIIn addition, the incremental prognostic value of AHI beyond albumin, hemoglobin, or other nutritional indicators was not directly assessed and warrants further investigation. Further multicenter studies are warranted to validate its external applicability, clinically relevant cutoff values, and incremental prognostic value.
Association of the admission albumin-hemoglobin index with postoperative outcomes in older adults with hip fracture: a post-hoc analysis of a prospective study · 2026 · DOIAlthough this parameter is associated with the risk of cephalic screw cutout, a definitive threshold for CalTAD has not yet been established, and it appears not to be superior to the tip–apex distance (TAD) in predicting cut-out. However, a definitive consensus on the interaction between these factors or their relative importance remains elusive.
Clinical Outcomes in the Treatment of Pertrochanteric Femur Fractures: A Retrospective Cohort Study · 2025 · DOIThe low (level 4) evidence provided by this retrospective, non-comparative study is a major limitation that necessitates the careful interpretation of the findings. The small number of cases, despite the rarity of this patient setting, is also a major limitation that further limits the generalizability of recommendations.
Guarded Outcomes After Hip Hemiarthroplasty in Patients with Cerebral Palsy: Highlighting a Personalized Medicine Approach to Mitigate the Risk of Complications · 2025 · DOIFuture research should focus on assay harmonization, cost-effectiveness, and interventional trials to establish whether biomarker-guided care can effectively reduce long-term cognitive decline.
One-Year Follow-Up Cognitive Decline After Hip Fracture Surgery: The Prognostic Role of NSE and S100B Biomarkers in Elderly Patients, a Multicentric Study · 2025 · DOIFuture prospective multicenter or registry-based studies with larger sample sizes are warranted to better delineate the comparative risk profiles of the two techniques.
Impact of limited intramedullary reaming versus unreamed technique in short proximal femoral nail anti-rotation for intertrochanteric fractures: a matched retrospective study · 2026 · DOIFuture research should focus on validating the stress riser effect in Group E using finite element analysis to visualize stress concentration points at the screw-plate interface. Several limitations of this study should be acknowledged.
Biomechanical comparison of inverted triangle and L-shaped screw configurations with medial buttress and anteromedial support plate in Pauwels type III femoral neck fractures · 2026 · DOITheir data are inconsistent: some favor delaying surgery, while others advocate for early surgical intervention under regional anesthesia with meticulous perioperative planning and multidisciplinary input.
The Co-Occurrence of Pertrochanteric Fracture and Acute Coronary Syndrome in a Geriatric Patient: A Case Report and Review of the Literature · 2026 · DOICurrently, there is only very limited data available regarding the impact of OGCM on preventing secondary fractures.
Association of orthogeriatric co-management with the occurrence of secondary fragility fractures in patients with an initial hip fracture · 2026 · DOIFuture research should investigate rehabilitation quality indicators, patient movement between settings, and long-term functional outcomes to provide a more comprehensive understanding of optimal rehabilitation strategies.
Comparing home-based and institutional rehabilitation for community-dwelling hip fracture patients: a matched cohort study · 2026 · DOILimitations of this study include its retrospective design, which is susceptible to temporal confounding and differences in case-mix between cohorts.
Future research should explore the impact of these interventions on both patient outcomes and healthcare resource utilisation, ensuring that national guidelines continue to evolve towards supporting equitable and efficient hip fracture management.
Time to surgery and its impact on length of stay and mortality for neck of femur fractures at a major trauma centre · 2026 · DOIIn conclusion, this study identified multiple independent risk factors for in-hospital implant- and bone-related complications after internal fixation for femoral neck fractures, an outcome rarely examined in previous literature, which has largely focused on long-term fixation failure such as non-union, avascular necrosis, or reoperation.
Factors associated with implant- and bone-related complications and fixation-failure–related readmissions after internal fixation for femoral neck fractures in young and middle-aged adults: a population-based study · 2026 · DOIRe-fractures distal to the femoral neck after implant removal have rarely been reported, with evidence largely limited to isolated case reports.
Re‑fracture risk following implant removal in consolidated hip fractures: a multicenter retrospective cohort study of 575 patients · 2026 · DOIThis finding contrasts with those of many previous studies that did not account for the clustered structure of data27–29.
Generalizability of a prediction model for walking independence at discharge in older adults after hip fracture surgery: a multicenter study · 2026 · DOIAlthough the exact cause of HO is not fully understood, certain risk factors have been identified, including the male gender, burns, stroke, spinal cord injury (SCI), traumatic and inflammatory brain injury, previous HO history, ankylosing spondylitis, previous hip surgery, hypertrophic osteoarthritis, lateral and anterolateral hip approaches, Paget’s disease, diffuse idiopathic skeletal hyperostosis, myelopathies…
Guarded Outcomes After Hip Hemiarthroplasty in Patients with Cerebral Palsy: Highlighting a Personalized Medicine Approach to Mitigate the Risk of Complications · 2025 · DOIFurther study on the long-term effects of the intervention, - Investigation into the generalizability of the results to other…
Implementing an identification tool to accurately capture non-ambulatory fragility fractures: a quality improvement project · 2026 · DOI
Most-cited papers in Hip and Femur Fractures
- Bone density at various sites for prediction of hip fractures · The Lancet · 1993 · 1,838 citations
- Zoledronic Acid and Clinical Fractures and Mortality after Hip Fracture · New England Journal of Medicine · 2007 · 1,659 citations
- Incidence and Mortality of Hip Fractures in the United States · JAMA · 2009 · 1,396 citations
- Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture · JAMA · 2006 · 960 citations
- Epidemiology and social costs of hip fracture · Injury · 2018 · 854 citations
- Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis · Canadian Medical Association Journal · 2010 · 793 citations
- Estimating Hip Fracture Morbidity, Mortality and Costs · Journal of the American Geriatrics Society · 2003 · 735 citations
- Predictors of Functional Recovery One Year Following Hospital Discharge for Hip Fracture: A Prospective Study · Journal of Gerontology · 1990 · 626 citations
- Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post‐Fracture Treatment, and All‐Cause Mortality · Journal of Bone and Mineral Research · 2023 · 583 citations
- Mortality, Disability, and Nursing Home Use for Persons with and without Hip Fracture: A Population‐Based Study · Journal of the American Geriatrics Society · 2002 · 563 citations
Most recent work
- The fracture orthopedic risk of non-home discharge (FORD) score: A novel bedside predictive tool for non-home discharge in orthopedic trauma patients · Injury · 2026
- What is the association between time to surgery and patient outcome after hip fracture? · The Bone & Joint Journal · 2026
- Digital mobility outcomes to describe real-world walking during recovery from a hip fracture: the Mobilise-D perspective · European Geriatric Medicine · 2026
- Integrated nutritional–inflammatory and frailty-based model for mortality risk stratification following hip fracture surgery: a multicentre cohort study · Aging Clinical and Experimental Research · 2026
- Dual mobility versus standard cups in total hip replacement for displaced femoral neck fractures (Duality): an international, multicentre, randomised, controlled, superiority trial · The Lancet · 2026
- Systemic inflammatory response following hip fracture in older people: postoperative CRP and PCT dynamics and their association with coagulation and renal function · GeroScience · 2026
- Intraoperative fluoroscopic evaluation of trochanteric fracture reduction using a novel anteromedial cortex view: A multicenter prospective observational study · Injury · 2026
- One-year mortality after first-time long bone fractures in older adults: A multicenter retrospective cohort study · Injury · 2026
- The effect of the preferred anesthesia method on early postoperative outcomes in elderly patients with hip fractures; a retrospective three-way comparative study · BMC Geriatrics · 2026
- Inpatient mortality following hip fracture in the United States: an updated analysis of over one million cases · European Journal of Orthopaedic Surgery & Traumatology · 2026
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