Application and Effect of "Internet + Nursing" in Hip Fragility Fracture Patients Based on Fracture Liaison Service

Osteoporotic fractures, also known as fragility fractures, refer to fractures occurring due to low-energy trauma or minor collisions. As the most severe complication of osteoporosis, they are common skeletal diseases in the elderly population . With China's gradual transition into an aging society, the incidence of fragility fractures has increased annually. Hip fractures, the most common type of fragility fracture, involve injuries to the femoral neck, intertrochanteric, and subtrochanteric regions of the femur . Referred to as the "last fracture in life," hip fractures are associated with high morbidity and mortality due to complications arising from advanced age, frailty, multiple comorbidities, and significant declines in self-care ability . Reports indicate that within one year of a hip fracture, only 30% of patients regain their pre-fracture functional status, 20% experience subsequent fractures, and some even face lifelong disability , severely impacting long-term quality of life. These statistics underscore the critical need for standardized management of hip fragility fractures.

Studies have reported that ineffective rehabilitation guidance, insufficient knowledge of rehabilitation training, and lack of scientific self-care capabilities are key factors influencing postoperative recovery in fragility fracture patients . Continuous nursing care, which addresses gaps in in-hospital health education, has become an indispensable component of postoperative care . Since 2015, nursing informatization has been promoted by national policies and plans, emerging as a major trend in nursing development . Driven by rapid technological advancements, the healthcare sector is encouraged to leverage "Internet+ Nursing Services" to explore new models of continuous care . This model, characterized by "online application and offline service," caters to discharged patients or individuals with mobility limitations, meeting their 刚需 for professional nursing services . As a vital component of continuous care, Internet+ Nursing Services play a positive role in rehabilitation guidance and enhancing patient self-management, improving nursing efficiency . However, current challenges exist: most services are provided by part-time clinical nurses without advanced education or referral coordination skills , and physician involvement is limited, leading to incomplete patient assessments during follow-ups. Additionally, reliance on mobile calls and WeChat for follow-ups raises concerns about information reliability. Thus, enhancing the quality of Internet+ Nursing Services for hip fragility fracture patients remains a critical clinical issue.

The fracture liaison service (FLS) is a multidisciplinary management model for osteoporotic fractures , comprising three key elements: identifying patients at fracture risk, assessing fall risk, and initiating treatments to prevent recurrent fractures. Its core involves dedicated coordinators linking emergency, orthopedic, rehabilitation, nutrition, and community services to provide standardized care, reducing fracture recurrence and promoting functional recovery. While FLS has been widely applied in fragility fracture care, its integration with remote nursing remains limited. This study aims to combine FLS with Internet+ Nursing Services, leveraging the informatic advantages of the latter to emphasize post-discharge risk assessment for recurrent fractures, home-based health guidance (e.g., fall prevention, rehabilitation training), online consultations with multidisciplinary teams, and offline home visits. By ensuring continuous medical care after discharge, this integrated model seeks to reduce complications and facilitate rapid recovery.

Inclusion criteria

Age ≥ 18 years

Voluntarily signed informed consent

Diagnosis of hip fragility fracture (closed type)

Scheduled for surgical intervention

Adequate communication and comprehension abilities

Ability of patient or caregiver to operate smart electronic devices

Exclusion criteria

History of psychiatric or neurological disorders (e.g., dementia, schizophrenia)

Polytrauma (multiple fractures or major concomitant injuries)

Metastatic cancer, metabolic bone disease, or terminal illness

Insulin-dependent diabetes mellitus

Thyroid disease

Inability to participate due to other medical or social factors