Hip fracture is a major cause of hospitalization, functional decline, loss of independence, and increased care requirements among older adults [1]. Although surgery permits fracture stabilization, pain relief, and early mobilization, postoperative recovery varies markedly [2]. Some patients regain transfer and walking ability within a few days, whereas others require prolonged inpatient care because of medical instability, poor mobility, complications, or greater rehabilitation needs [3]. Discharge after hip fracture surgery depends on both clinical stability and functional capacity. Adequate pain control, oral intake, wound status, safe transfers, and an appropriate level of assisted ambulation are important before transition from acute care [4]. Predicting delayed discharge readiness early may allow timely involvement of physiotherapy, geriatric and medical teams, caregivers, and rehabilitation services and may reduce avoidable delays once recovery milestones are achieved [5]. Chronological age alone does not adequately describe an elderly patient's ability to recover from acute injury and surgery [6]. Frailty represents reduced physiological reserve and increased vulnerability to stressors [7]. Hip fracture, anaesthesia, surgery, pain, blood loss, and immobility impose substantial physiological demands; patients with greater frailty may therefore experience slower mobilization, more complications, and prolonged dependency [8]. The Clinical Frailty Scale (CFS) provides a practical assessment of baseline fitness, vulnerability, and dependency [9]. Pre-fracture mobility is another important indicator of recovery potential. Mobility before injury reflects lower-limb function, balance, endurance, and independence [10]. The Parker Mobility Score (PMS) evaluates mobility within the home, outside the home, and during community activities [11]. Because acute fracture prevents meaningful direct performance testing, assessment of usual mobility immediately before injury offers a useful estimate of baseline functional reserve [12]. Frailty and mobility are related but distinct. Frailty captures broader physiological vulnerability, whereas PMS focuses on locomotor independence [13]. Their combined assessment may therefore provide more prognostic information than either measure alone [14]. Other factors such as age, comorbidity, cognitive impairment, time to surgery, postoperative complications, and rehabilitation progress can also influence discharge readiness and should be considered when evaluating independent predictive value [15]. This prospective cohort study evaluated the predictive value of preoperative CFS and pre-fracture PMS for discharge readiness following hip fracture surgery in elderly patients at a tertiary care hospital in India. Their individual and combined predictive performance was examined together with relevant demographic, clinical, surgical, and postoperative factors. Aim and Objectives Aim To determine the predictive value of preoperative frailty and pre-fracture functional mobility for postoperative discharge readiness following hip fracture surgery in elderly patients. Primary Objective To determine the association of preoperative Clinical Frailty Scale score and pre-fracture Parker Mobility Score with achievement of discharge readiness by postoperative day 5 following hip fracture surgery. Secondary Objectives To compare frailty and pre-fracture mobility between patients achieving discharge readiness by postoperative day 5 and those with delayed readiness, and to examine their relationship with time to readiness and hospital stay. To assess associations with early mobilization, postoperative complications, and discharge destination, and to identify independent predictors after adjustment for relevant clinical variables. To evaluate the discriminative performance of CFS and PMS individually and in combination for predicting discharge readiness by postoperative day 5.

Study Design and Setting This prospective observational cohort study was conducted in the Department of Orthopaedics at a tertiary care hospital in India and included elderly patients undergoing operative treatment for acute hip fracture. Study Duration The study was conducted over 18 months from January 2025 to June 2026. Study Population Patients aged ≥65 years with acute proximal femoral fractures requiring surgery were enrolled consecutively after initial stabilization and preoperative evaluation. Sample Size The sample size was based on the primary outcome of discharge readiness by postoperative day 5. Assuming approximately 55–60% early readiness and allowing adequate power for multivariable prediction, at least 135 evaluable patients were required. Allowing approximately 10% for exclusions or incomplete assessment, 150 patients were targeted. Of 158 screened patients, eight were excluded and 150 constituted the final cohort. Sampling Technique Consecutive eligible patients admitted during the recruitment period were enrolled until the required sample size was achieved. Inclusion Criteria Patients aged ≥65 years with radiologically confirmed femoral neck, intertrochanteric, or subtrochanteric fractures managed surgically were included. Participants had been ambulatory before fracture, independently or with an aid, and reliable pre-fracture functional information was available from the patient or a close caregiver. Exclusion Criteria Patients managed conservatively or presenting with pathological, periprosthetic, or high-energy polytrauma-related fractures were excluded. Other exclusions were complete pre-fracture non-ambulation, advanced neurological or neuromuscular disease causing profound mobility limitation, unavailable baseline functional information, death before outcome assessment, or a catastrophic postoperative event preventing meaningful discharge-readiness evaluation. Baseline Assessment Age, sex, BMI, living arrangement, fracture type, comorbidities, cognitive impairment, pre-fracture walking-aid use, time to surgery, anaesthetic and surgical details, perioperative haemoglobin, and postoperative clinical events were prospectively recorded using a structured proforma. Assessment of Preoperative Frailty Frailty was assessed preoperatively using the Clinical Frailty Scale (CFS), reflecting the patient's usual status immediately before fracture rather than acute fracture-related disability. For analysis, CFS 1–3 represented non-frail/managing well, CFS 4 vulnerable, CFS 5 mildly frail, and CFS ≥6 moderate-to-severe frailty. The score was also analysed continuously. When required, baseline information was obtained from a reliable caregiver. Assessment of Pre-Fracture Functional Mobility Pre-fracture mobility was assessed using the Parker Mobility Score (PMS), which evaluates mobility inside the home, outside the home, and during community activities, producing a score from 0 to 9. Higher scores indicate greater independence. PMS was categorized as poor (0–3), moderate (4–6), or good (7–9) mobility and was retained as a continuous variable for regression and ROC analyses. Preoperative Clinical Management All patients underwent standard clinical and anaesthetic assessment, pain management, laboratory and radiographic evaluation, correction of reversible abnormalities, and optimization of comorbidities. Antibiotic prophylaxis and thromboprophylaxis followed institutional protocols, with surgery undertaken as soon as clinically feasible. Surgical Management Surgery was selected according to fracture pattern, bone quality, pre-fracture function, and clinical judgement. Femoral neck fractures were treated with hemiarthroplasty or total hip arthroplasty when indicated; intertrochanteric and subtrochanteric fractures underwent appropriate internal fixation, predominantly proximal femoral nail fixation. Postoperative Management Postoperative care included analgesia, thromboprophylaxis, wound care, fluid and nutritional management, and treatment of medical conditions. Haemoglobin, transfusion requirement, delirium, urinary or respiratory infection, acute kidney injury, cardiovascular events, wound problems, and other significant complications were recorded. Postoperative Mobilization and Rehabilitation Physiotherapy began as early as clinically feasible and progressed from bed mobility and sitting to transfers, standing, and ambulation with an appropriate aid. Weight-bearing was determined by the surgical procedure and fixation stability. Achievement of out-of-bed mobilization and assisted ambulation was documented daily. Assessment of Postoperative Discharge Readiness Discharge readiness was assessed daily using predefined criteria: haemodynamic and medical stability; no unresolved major complication requiring acute care; adequate pain control with oral medication; tolerance of oral intake and essential medication; satisfactory wound status; safe essential transfers; clinically appropriate assisted ambulation; and identification of a suitable discharge destination with required caregiver or rehabilitation support. Readiness was distinguished from actual discharge because non-medical logistical factors could delay hospital departure. Definition of Early Discharge Readiness The primary outcome was discharge readiness by postoperative day 5. Patients meeting all criteria on or before day 5 were classified as early-ready; those meeting them later were classified as having delayed readiness. The first day on which criteria were fulfilled was recorded. Postoperative Complications Clinically significant postoperative complications were recorded individually and as a composite variable indicating at least one complication. Discharge Destination Discharge destination was categorized as home with family/caregiver support, home with additional rehabilitation or healthcare assistance, or inpatient rehabilitation/institutional care. Outcome Measures Primary Outcome The primary outcome was discharge readiness by postoperative day 5, categorized as early or delayed readiness. Secondary Outcomes Secondary outcomes were time to readiness, hospital length of stay, early postoperative mobility, complications, and discharge destination. Primary Predictor Variables The principal predictors were preoperative CFS and pre-fracture PMS, evaluated individually and in combination. Data Collection and Quality Control Data were recorded prospectively using a standardized case-record form. Baseline status was distinguished from acute fracture-related disability, and clinical and outcome data were checked for completeness before analysis. Statistical Analysis Continuous data were summarized as mean ± SD or median (IQR), and categorical data as frequency and percentage. Early- and delayed-readiness groups were compared using independent-samples t-test or Mann–Whitney U test for continuous variables and chi-square or Fisher's exact test for categorical variables. Trends across CFS and PMS categories were assessed. Multivariable binary logistic regression identified independent predictors of discharge readiness by day 5, with CFS and PMS as principal variables and adjustment for age, sex, comorbidity burden, fracture type, time to surgery, and postoperative complications. Adjusted odds ratios (ORs) with 95% confidence intervals were reported. ROC analysis evaluated CFS, PMS, their combined model, and the full adjusted model; AUC, sensitivity, and specificity were calculated. Two-sided p<0.05 was considered statistically significant. Ethical Considerations Institutional Ethics Committee approval was obtained. Written informed consent was taken from competent participants or a legally acceptable representative when required. Confidentiality was maintained, and participation did not alter standard clinical management or discharge planning.

Among 150 patients, mean age was 77.4 ± 7.6 years and 91 (60.7%) were women. Median CFS was 4 (IQR 3–5) and mean PMS was 6.1 ± 2.2. Overall, 87 (58.0%) achieved discharge readiness by postoperative day 5 and 63 (42.0%) had delayed readiness. Early-ready patients were younger, had fewer comorbidities and complications, lower frailty [CFS 3 (3–4) vs 5 (4–6), p<0.001], and better pre-fracture mobility (PMS 7.1 ± 1.6 vs 4.7 ± 2.0, p<0.001). Readiness declined progressively with increasing CFS and improved with higher PMS. In adjusted analysis, CFS (OR 0.54 per point, 95% CI 0.38–0.76) and PMS (OR 1.48 per point, 95% CI 1.19–1.84) remained independent predictors. CFS and PMS yielded AUCs of 0.78 and 0.80, while their combined model achieved an AUC of 0.87. Patients with high frailty and poor mobility had slower mobilization, more complications, longer time to readiness, and longer hospital stay. Table 1. Baseline Demographic, Clinical and Fracture Characteristics of the Study Population (n = 150) Variable Value Age (years), mean ± SD 77.4 ± 7.6 65–74 years, n (%) 56 (37.3) 75–84 years, n (%) 68 (45.3) ≥85 years, n (%) 26 (17.3) Male, n (%) 59 (39.3) Female, n (%) 91 (60.7) BMI (kg/m²), mean ± SD 23.7 ± 3.8 Living at home before fracture, n (%) 137 (91.3) Hypertension, n (%) 86 (57.3) Diabetes mellitus, n (%) 51 (34.0) Ischaemic heart disease, n (%) 28 (18.7) Chronic respiratory disease, n (%) 19 (12.7) Chronic kidney disease, n (%) 14 (9.3) Previous cerebrovascular disease, n (%) 17 (11.3) Pre-existing cognitive impairment, n (%) 22 (14.7) ≥2 major comorbidities, n (%) 79 (52.7) Femoral neck fracture, n (%) 70 (46.7) Intertrochanteric fracture, n (%) 68 (45.3) Subtrochanteric fracture, n (%) 12 (8.0) Hemiarthroplasty/THA, n (%) 68 (45.3) Internal fixation, n (%) 82 (54.7) Surgery within 48 hours of admission, n (%) 112 (74.7) CFS, median (IQR) 4 (3–5) PMS, mean ± SD 6.1 ± 2.2 Table 2. Comparison of Patients With Early and Delayed Discharge Readiness Variable Ready by Day 5 (n = 87) Delayed Readiness (n = 63) p-value Age (years) 74.9 ± 6.5 80.8 ± 7.7 <0.001 Female, n (%) 49 (56.3) 42 (66.7) 0.201 BMI (kg/m²) 23.9 ± 3.6 23.4 ± 4.0 0.425 ≥2 major comorbidities, n (%) 36 (41.4) 43 (68.3) 0.001 Cognitive impairment, n (%) 7 (8.0) 15 (23.8) 0.007 CFS, median (IQR) 3 (3–4) 5 (4–6) <0.001 PMS, mean ± SD 7.1 ± 1.6 4.7 ± 2.0 <0.001 Surgery within 48 hours, n (%) 72 (82.8) 40 (63.5) 0.007 Postoperative complication, n (%) 15 (17.2) 29 (46.0) <0.001 Mobilized out of bed by POD 1, n (%) 68 (78.2) 29 (46.0) <0.001 Assisted ambulation achieved by POD 3, n (%) 75 (86.2) 28 (44.4) <0.001 Time to discharge readiness, days, median (IQR) 4 (3–5) 8 (7–10) <0.001 Hospital length of stay, days, median (IQR) 7 (6–8) 11 (9–14) <0.001 POD = postoperative day. Table 3. Discharge Readiness According to Preoperative Frailty and Pre-Fracture Mobility Category Total n Ready by Day 5, n (%) Delayed Readiness, n (%) p-value Clinical Frailty Scale <0.001 CFS 1–3 48 41 (85.4) 7 (14.6) CFS 4 39 27 (69.2) 12 (30.8) CFS 5 35 15 (42.9) 20 (57.1) CFS ≥6 28 4 (14.3) 24 (85.7) Parker Mobility Score <0.001 PMS 0–3 24 4 (16.7) 20 (83.3) PMS 4–6 54 27 (50.0) 27 (50.0) PMS 7–9 72 56 (77.8) 16 (22.2) Table 4. Postoperative Recovery, Complications and Discharge Destination According to Discharge-Readiness Status Outcome Ready by Day 5 (n = 87) Delayed Readiness (n = 63) p-value Any postoperative complication, n (%) 15 (17.2) 29 (46.0) <0.001 Delirium, n (%) 5 (5.7) 14 (22.2) 0.003 Transfusion-requiring anaemia, n (%) 7 (8.0) 13 (20.6) 0.025 Urinary tract infection, n (%) 3 (3.4) 8 (12.7) 0.032 Respiratory infection, n (%) 2 (2.3) 7 (11.1) 0.034 Acute kidney injury, n (%) 2 (2.3) 6 (9.5) 0.066 Mobilized out of bed by POD 1, n (%) 68 (78.2) 29 (46.0) <0.001 Assisted ambulation by POD 3, n (%) 75 (86.2) 28 (44.4) <0.001 Discharged home with family/caregiver, n (%) 76 (87.4) 35 (55.6) <0.001 Home with additional rehabilitation support, n (%) 8 (9.2) 14 (22.2) 0.025 Inpatient rehabilitation/institutional care, n (%) 3 (3.4) 14 (22.2) <0.001 Table 5. Multivariable Logistic Regression for Predictors of Discharge Readiness by Postoperative Day 5 Predictor Adjusted OR 95% CI p-value CFS, per 1-point increase 0.54 0.38–0.76 <0.001 PMS, per 1-point increase 1.48 1.19–1.84 <0.001 Age, per 1-year increase 0.95 0.90–0.99 0.028 Female sex 0.81 0.36–1.82 0.607 ≥2 major comorbidities 0.58 0.27–1.25 0.166 Surgery within 48 hours 1.93 0.85–4.39 0.116 Any postoperative complication 0.38 0.17–0.85 0.018 Model Nagelkerke R² = 0.52; overall model p<0.001. Table 6. Predictive Performance of Frailty and Functional Mobility for Discharge Readiness by Postoperative Day 5 Prediction Model AUC 95% CI Sensitivity (%) Specificity (%) p-value CFS alone 0.78 0.71–0.85 74.7 71.4 <0.001 PMS alone 0.80 0.73–0.87 77.0 73.0 <0.001 Combined CFS + PMS 0.87 0.81–0.92 82.8 79.4 <0.001 Full adjusted model 0.89 0.84–0.94 85.1 81.0 <0.001 AUC = area under the receiver operating characteristic curve. Table 7. Time to Discharge Readiness and Hospital Stay According to Combined Frailty-Mobility Profile Combined Preoperative Profile n Ready by Day 5, n (%) Time to Readiness, Median Days (IQR) Hospital Stay, Median Days (IQR) Low frailty + good mobility 47 42 (89.4) 4 (3–4) 7 (6–8) Intermediate profile 65 38 (58.5) 5 (4–8) 9 (7–11) High frailty + poor mobility 38 7 (18.4) 9 (7–11) 13 (10–15) p-value <0.001 <0.001 <0.001 Low frailty + good mobility was defined as CFS ≤4 with PMS ≥7; high frailty + poor mobility was defined as CFS ≥5 with PMS ≤6. Remaining combinations constituted the intermediate profile. Tables Summary Table 1 The cohort was elderly (mean 77.4 years), predominantly female, and medically complex; 52.7% had at least two major comorbidities. Femoral neck and intertrochanteric fractures accounted for 92.0% of injuries, and 74.7% underwent surgery within 48 hours. Baseline CFS and PMS values demonstrated substantial variation in frailty and mobility. Table 2 Patients ready by day 5 were younger and had fewer comorbidities and less cognitive impairment. They had markedly lower CFS and higher PMS, were more often operated within 48 hours, experienced fewer complications, and mobilized earlier. Median time to readiness was 4 versus 8 days, and hospital stay was 7 versus 11 days (all key comparisons p<0.001). Table 3 A strong graded relationship was evident. Early readiness fell from 85.4% with CFS 1–3 to 14.3% with CFS ≥6. Conversely, readiness increased from 16.7% with PMS 0–3 to 77.8% with PMS 7–9 (p<0.001), demonstrating clinically meaningful stratification by both measures. Table 4 Delayed-readiness patients had more postoperative complications, particularly delirium, transfusion-requiring anaemia, urinary infection, and respiratory infection. They were less likely to mobilize by day 1 or ambulate by day 3 and more frequently required additional rehabilitation or institutional care. Table 5 After adjustment, higher CFS independently reduced the odds of readiness (OR 0.54 per point), whereas higher PMS increased the odds (OR 1.48 per point). Increasing age and postoperative complications were also independent adverse predictors. The model explained approximately 52% of outcome variability. Table 6 CFS and PMS individually showed useful discrimination (AUC 0.78 and 0.80). Combining them improved AUC to 0.87 with 82.8% sensitivity and 79.4% specificity; the full adjusted model produced only a modest further increase to 0.89. Table 7 The combined profile showed a clear recovery gradient. Early readiness occurred in 89.4% of patients with low frailty/good mobility but only 18.4% with high frailty/poor mobility. Median readiness time increased from 4 to 9 days and hospital stay from 7 to 13 days across these groups.

This study demonstrated that preoperative frailty and pre-fracture mobility were strong predictors of discharge readiness after hip fracture surgery. Patients ready by postoperative day 5 had substantially lower CFS and higher PMS, and both measures remained independently predictive after adjustment for demographic and perioperative factors. Their combined model performed better than either measure alone, supporting assessment of both physiological vulnerability and baseline locomotor function [1,2]. Frailty showed a clear dose-response relationship with recovery. Early readiness decreased from 85.4% in patients with CFS 1–3 to 14.3% in those with CFS ≥6. Hip fracture and surgery impose acute physiological stress through pain, blood loss, anaesthesia, inflammation, and immobility [3]. Patients with limited reserve are less able to compensate and may therefore require longer to regain medical stability and functional independence. The CFS appears to capture this vulnerability more effectively than chronological age alone [4]. Pre-fracture mobility was similarly important. Only 16.7% of patients with PMS 0–3 achieved readiness by day 5 compared with 77.8% of those scoring 7–9. Baseline mobility reflects muscle strength, balance, endurance, confidence, and independence [5]. Patients who were mobile before injury are more likely to have sufficient functional reserve for postoperative transfer training and ambulation, whereas those already dependent before fracture may require more intensive rehabilitation [6]. CFS and PMS should not be viewed as interchangeable. CFS reflects broader health, vulnerability, and dependency, while PMS specifically describes habitual mobility. This distinction probably explains why combining them improved discrimination from AUC 0.78–0.80 individually to 0.87. The full model increased AUC only to 0.89, suggesting that these two simple preoperative measures captured a large proportion of clinically relevant predictive information [7,8]. Early mobilization was closely associated with readiness. Among early-ready patients, 78.2% were mobilized out of bed by postoperative day 1 and 86.2% achieved assisted ambulation by day 3, compared with 46.0% and 44.4% respectively in the delayed group [9]. These findings emphasize that discharge readiness after hip fracture surgery is not determined by medical stability alone; restoration of safe transfers and ambulation is central to transition from acute care [10]. Postoperative complications also influenced recovery. Almost half of delayed-readiness patients experienced at least one significant complication compared with 17.2% of early-ready patients [11]. Delirium, anaemia requiring transfusion, urinary infection, and respiratory infection were more frequent in the delayed group, and complications remained independently associated with lower odds of readiness [12]. Frail patients may be particularly susceptible to such events, creating an interaction between baseline vulnerability and postoperative recovery [13]. The combined frailty-mobility profile provided clinically useful stratification. Nearly 90% of patients with low frailty and good mobility were ready by day 5, whereas only 18.4% with high frailty and poor mobility achieved this endpoint [14]. The latter group required a median of 9 days to meet criteria and stayed a median of 13 days. Such information may help teams anticipate physiotherapy intensity, caregiver needs, rehabilitation placement, and likely bed utilization from the time of admission [15]. These findings are relevant to tertiary care practice in India, where post-acute rehabilitation resources and family support vary considerably. CFS and PMS are rapid assessments requiring no specialized equipment and may complement age, comorbidity, fracture characteristics, and surgical factors. They should not be used to deny treatment or impose fixed discharge timelines; rather, high-risk profiles should trigger earlier multidisciplinary rehabilitation and discharge planning, while lower-risk patients may be prepared for timely transition once clinical and functional criteria are satisfied. Strengths of the Study The prospective design allowed standardized baseline assessment and daily evaluation of discharge readiness. Use of both CFS and PMS captured complementary domains of vulnerability and mobility. Readiness was defined by clinical and functional criteria rather than actual discharge date, reducing the influence of administrative delays. Multivariable and ROC analyses further quantified independent and combined predictive performance. Limitations This was a single-centre study, so findings may vary in settings with different patient profiles, rehabilitation resources, and discharge practices. Pre-fracture mobility and frailty were reconstructed after injury and may be affected by recall or proxy reporting. The discharge-readiness definition incorporated clinical judgement, and detailed measures of nutrition, sarcopenia, socioeconomic status, and formal cognition were not included. Longer-term outcomes such as readmission, mortality, and recovery of independent mobility were outside the study scope. Clinical Implications Routine assessment of CFS and PMS at admission may help identify patients likely to require prolonged recovery, more intensive physiotherapy, or additional post-discharge support. Patients with both substantial frailty and poor mobility represent a particularly high-risk group. Early recognition may facilitate coordinated perioperative management, caregiver counselling, rehabilitation planning, and more efficient use of inpatient resources.

Preoperative frailty and pre-fracture functional mobility independently predicted discharge readiness after hip fracture surgery in elderly patients. Increasing CFS was associated with progressively lower likelihood of readiness by postoperative day 5, whereas higher PMS increased the probability of timely recovery. Patients with high frailty and poor mobility also had slower mobilization, more complications, longer time to readiness, and greater rehabilitation requirements. Combined CFS and PMS assessment provided better discrimination than either measure alone and offers a simple, clinically applicable approach to early risk stratification. These measures should complement, rather than replace, assessment of medical stability, complications, cognition, social support, and rehabilitation progress. Multicentre validation is warranted before incorporation into standardized discharge pathways.

1. Ferris H, Brent L, Sorensen J, Ahern E, Coughlan T. Discharge destination after hip fracture: findings from the Irish hip fracture database. Eur Geriatr Med. 2022 Apr;13(2):415-424. doi: 10.1007/s41999-021-00556-7. Epub 2021 Aug 22. PMID: 34420192. 2. Lin DY, Brown B, Morrison C, Kroon HM, Jaarsma RL. Pericapsular nerve group block results in a longer analgesic effect and shorter time to discharge than femoral nerve block in patients after hip fracture surgery: a single-center double-blinded randomized trial. J Int Med Res. 2022 Mar;50(3):3000605221085073. doi: 10.1177/03000605221085073. PMID: 35291842; PMCID: PMC8935563. 3. Sheehan KJ, Sobolev B, Villán Villán YF, Guy P. Patient and system factors of time to surgery after hip fracture: a scoping review. BMJ Open. 2017 Aug 21;7(8):e016939. doi: 10.1136/bmjopen-2017-016939. PMID: 28827264; PMCID: PMC5724192. 4. Haslam-Larmer L, Donnelly C, Auais M, Woo K, DePaul V. Early mobility after fragility hip fracture: a mixed methods embedded case study. BMC Geriatr. 2021 Mar 15;21(1):181. doi: 10.1186/s12877-021-02083-3. PMID: 33722193; PMCID: PMC7962231. 5. Tabu I, Goh EL, Appelbe D, Parsons N, Lekamwasam S, Lee JK, Amphansap T, Pandey D, Costa M; FERMAT collaborators and the Global Fragility Fracture Network Hip Fracture Audit Special Interest Group. Service availability and readiness for hip fracture care in low- and middle-income countries in South and Southeast Asia. Bone Jt Open. 2023 Sep 5;4(9):676-681. doi: 10.1302/2633-1462.49.BJO-2023-0075.R1. PMID: 37666496; PMCID: PMC10477024. 6. Mert SA, Çiçek AC. Return to sexual activity after total hip arthroplasty: a comparative study of emergency or elective total hip arthroplasty patients. Arch Orthop Trauma Surg. 2025 Oct 3;145(1):458. doi: 10.1007/s00402-025-06083-5. PMID: 41042277. 7. Jensen TG, Vinstrup LØ, Dalskov S, Aasbrenn M, Palm H, Rugolo SA, Vendelø MT, Dollerup S, Eriksen SAN, Lunn TH. Introducing the "hip call" to facilitate early surgical treatment of hip fractures: A feasibility study. Acta Anaesthesiol Scand. 2020 Sep;64(8):1202-1209. doi: 10.1111/aas.13615. Epub 2020 Jun 5. PMID: 32392360. 8. Myint MW, Wu J, Wong E, Chan SP, To TS, Chau MW, Ting KH, Fung PM, Au KS. Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. Age Ageing. 2013 Jan;42(1):39-45. doi: 10.1093/ageing/afs078. Epub 2012 Jun 8. PMID: 22685164. 9. van Rijckevorsel VAJIM, de Jong L, Klem TMAL, Kuijper TM, Roukema GR. Drain versus no drain after hip hemi-arthroplasty for femoral neck fractures; differences in clinical outcomes. Eur J Trauma Emerg Surg. 2022 Jun;48(3):1799-1805. doi: 10.1007/s00068-020-01528-5. Epub 2020 Oct 21. PMID: 33084918. 10. EDUCATE Investigators. Assessing readiness to manage intimate partner violence 12 months after completion of an educational program in fracture clinics: a pretest-posttest study. CMAJ Open. 2020 Nov 16;8(4):E731-E736. doi: 10.9778/cmajo.20200031. PMID: 33199506; PMCID: PMC7676989. 11. Zhang Y, Chen X, Zhang Y, Liu Y, Zhang H. A scoping review of the current status of continuity of care needs and factors influencing them in older adults with hip fractures in China. Front Public Health. 2025 Nov 25;13:1667307. doi: 10.3389/fpubh.2025.1667307. PMID: 41377718; PMCID: PMC12685847. 12. Goyal A, Gupta M, Mishra AK, Bhuvneshwar. Total Hip Arthroplasty for Neglected Hip Dislocation - Surgical Technique and Results. J Orthop Case Rep. 2025 Dec;15(12):157-162. doi: 10.13107/jocr.2025.v15.i12.6490. PMID: 41509739; PMCID: PMC12778993. 13. Che YJ, Qian Z, Chen Q, Chang R, Xie X, Hao YF. Effects of rehabilitation therapy based on exercise prescription on motor function and complications after hip fracture surgery in elderly patients. BMC Musculoskelet Disord. 2023 Oct 14;24(1):817. doi: 10.1186/s12891-023-06806-y. PMID: 37838680; PMCID: PMC10576877. 14. Bhushan S, Huang X, Duan Y, Xiao Z. The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: A systematic review and meta-analysis. Int J Surg. 2022 Sep;105:106854. doi: 10.1016/j.ijsu.2022.106854. Epub 2022 Aug 27. PMID: 36031067. 15. Loggers SAI, Van Lieshout EMM, Joosse P, Verhofstad MHJ, Willems HC. Prognosis of nonoperative treatment in elderly patients with a hip fracture: A systematic review and meta-analysis. Injury. 2020 Nov;51(11):2407-2413. doi: 10.1016/j.injury.2020.08.027. Epub 2020 Aug 23. PMID: 32907702.