Fragility fractures, also known as osteoporotic fractures, are fractures that occur as a result of low-energy trauma or minor impact. They are the most serious complication of osteoporosis and are common bone diseases in the elderly. With our country gradually entering the aging society, the incidence of brittle fracture is increasing year by year, most often in the hip. Hip fracture refers to femoral neck, intertrochanteric and subtrochanteric fractures. Due to a series of complications caused by old age, weak body, many underlying diseases, significant decline in self-care ability and other reasons, it is also known as the last fracture in life. According to reports, within 1 year after hip fracture, only 30% of patients can recover to the functional state before fracture, 20% of patients will fracture again, and even cause lifelong disability, seriously affecting the long-term quality of life of patients, the reason may be related to the long course of disease, slow recovery, postoperative nutrition, rehabilitation exercise compliance, self-care ability decline and many other aspects. The fracture liaison service (FLS) is a nurse-centric, multidisciplinary approach to managing osteoporotic fractures that consists of three key elements: The core of identifying patients with fracture risk, assessing fall risk and initiating treatment to prevent refracture is to hire specialized coordinators to link emergency, orthopedics, rehabilitation, nutrition and other departments with community and family services to provide standardized management services for patients, reduce the incidence of refracture and promote the recovery of joint function of patients. Therefore, this study integrates FLS with "Internet + nursing service" and utilizes the advantages of "Internet + nursing service" in informatization to emphasize the risk assessment of re-fracture of patients at home after discharge, home health guidance (such as fall prevention, rehabilitation training and other related knowledge), online consultation of multidisciplinary teams, offline on-site service, etc., so that patients can be discharged from hospital. Access to ongoing medical care reduces the incidence of complications and promotes rapid recovery.
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Parallel
On the basis of routine nursing, the "Internet + nursing program" based on the FLS model is implemented
Other intervention1\) During hospitalization: After the patient is admitted to hospital, the coordinator will establish wechat contact with the patient face to face and establish a good trust relationship with the patient; The coordinator and the doctor will collect the patients' cases together, and then according to the patients' conditions and wishes, the diagnosis and treatment plan will be formulated jointly by multiple disciplines, including medicine, rehabilitation and nutrition management. 2) Before discharge: the coordinator helps the patient to make an appointment for return visit; Issue business cards of the team's online and offline services to patients and guide them to use wechat and online service application procedures (such as Zheli Care and Dr. Nari); 3) After discharge: patients keep in touch with the liaison staff at any time, and any abnormal situation will be contacted by the liaison staff; Team members supervised the patient's medication situation by punching in the mini program
Daily Living Ability Rating Scale (ADL)
Activities of Daily Living (Barthel Index): Used to assess patients' ability to perform daily living activities. The assessment includes: eating, bathing, grooming, dressing, toileting, mobility, bed-chair transfer, stair climbing, and bowel/bladder control. A total score of 100 indicates complete independence without reliance on others; 61-99 points indicate basic independence in daily life; 41-60 points indicate moderate dependence requiring assistance; 21-40 points indicate significant dependence on others for daily activities; and ≤20 points indicate complete dependence on others.
Harris Hip Joint Function Scale
Harris Hip Rating Scale: This study uses the Harris Hip Rating Scale, the most widely applied hip assessment tool in North American hip scoring criteria. Developed by Harris in the United States in 1969, the scale consists of 10 items with respective maximum scores as follows: Pain (44 points), Stair climbing (4 points), Putting on and removing shoes and socks (4 points), Sitting in a chair (5 points), Car travel (1 point), Gait (11 points), Walking aid use (11 points), Walking distance (11 points), Deformity (4 points), and Range of motion (5 points). The total score is 100 points, categorized into four grades: excellent (90-100 points), good (80-90 points), fair (70-80 points), and poor (below 70 points).
Complications
Complications (incidence of recurrent fractures, infection, pressure ulcers, dislocation, etc.).
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