Introduction: Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. Methods: Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. Results: Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. Conclusion: The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.

Neck of femur (NOF) fractures are a critical orthopaedic emergency with a high morbidity and mortality prevalence, particularly in people living with Human Immunodeficiency Virus (PLWHIV). A combination of HIV infection, combined antiretroviral therapy (cART), and compromised bone health further increases the risk of fragility fractures. Additionally, HIV-related immune dysfunction, cART-induced osteoporosis, and perioperative infection risks further pose challenges in ongoing surgical management. Despite the rising global prevalence of PLWHIV, no specific guidelines exist for the perioperative and post-operative care of PLWHIV undergoing NOF fracture surgery. This narrative review synthesises the current literature on the surgical management of NOF fractures in PLWHIV, focusing on pre-operative considerations, intraoperative strategies, post-operative complications, and long-term outcomes. It also explores infection control, fracture healing dynamics, and ART’s impact on surgical outcomes while identifying key research gaps. A systematic database search (PubMed, Embase, Cochrane Library) identified relevant studies published up to February 2025. Inclusion criteria encompassed studies on incidence, risk factors, ART impact, and NOF fracture outcomes in PLWHIV. Data were analysed to summarise findings and highlight knowledge gaps. Pre-operative care: Optimisation involves assessing immune status (namely, CD4 counts and HIV-1 viral loads), bone health, and cART to minimise surgical risk. Immunodeficiency increases surgical site and periprosthetic infection risks, necessitating potential enhanced antibiotic prophylaxis and close monitoring of potential start/switch/stopping of such therapies. Surgical management of neck of femur (NOF) fractures in PLWHIV should be individualised based on fracture type (intracapsular or extracapsular), age, immune status, bone quality, and functional status. Extracapsular fractures are generally managed with internal fixation using dynamic hip screws or intramedullary nails. For intracapsular fractures, internal fixation may be appropriate for younger patients with good bone quality, though there is an increased risk of non-union in this group. Hemiarthroplasty is typically favoured in older or frailer individuals, offering reduced surgical stress and lower operative time. Total hip arthroplasty (THA) is considered for active patients or those with pre-existing hip joint disease but carries a higher infection risk in immunocompromised individuals. Multidisciplinary evaluation is critical in guiding the most suitable surgical approach for PLWHIV. Importantly, post-operative care carries the risk of higher infection rates, requiring prolonged antibiotic use and wound surveillance. Antiretroviral therapy (ART) contributes to bone demineralisation and chronic inflammation, increasing delayed union healing and non-union risk. HIV-related frailty, neurocognitive impairment, and socioeconomic barriers hinder rehabilitation, affecting recovery. The management of NOF fractures in PLWHIV requires a multidisciplinary, patient-centred approach ideally comprising a team of Orthopaedic surgeon, HIV Physician, Orthogeriatric care, Physiotherapy, Occupational Health, Dietitian, Pharmacist, Psychologist, and related Social Care. Optimising cART, tailoring surgical strategies, and enforcing strict infection control can improve outcomes. Further high-quality studies and randomised controlled trials (RCTs) are essential to develop evidence-based guidelines.

Background Preparedness to manage acutely ill patients is a critical competency for new medical graduates, yet there are persisting gaps in acute-care management teaching throughout undergraduate training. To address this, we developed the Systematic Approach for the Acutely ill Patient (SAAP) course, a peer-led, simulation-based medical education (SBME) programme designed to give pre-clinical medical students a solid foundation in acute illness management. The course aimed to improve their knowledge and confidence in managing acutely ill patients, thereby better preparing them for the transition into clinical training. Methods This pilot quasi-experimental study employed a pre-and post-test design involving 70 pre-clinical medical students at a UK university. The SAAP course comprised four workshops based on the RATE framework (Recognise, Assess, Treatment, Escalation), followed by simulation scenarios facilitated by near-peer instructors. Students completed knowledge tests and confidence questionnaires before and after the simulation and provided qualitative feedback at the end of the course. Data were analysed using paired ttests for knowledge scores and Mann-Whitney U tests for questionnaire responses. Results There was a significant increase in knowledge score across the study cohort (mean pre-test score 20.36 to post-test 22.17, p < 0.001). First-year students (19.03 to 21.08, p < 0.001) demonstrated the larger improvement compared to second-year students (22.03 to 23.55, p < 0.001). Confidence scores rose significantly in multiple domains, including ordering appropriate investigations (3.24 to 3.83, p < 0.001), managing patients with breathing difficulties (3.46 to 3.91, p < 0.001), managing hypotension (3.50 to 3.89, p < 0.00), and using the Identify, Situation, Background, Assessment, Recommendation (ISBAR) framework for escalation (3.77 to 4.06, p = 0.004). Overall confidence in acute-care management improved from 3.46 to 3.86 (p < 0.001). Qualitative feedback highlighted the value of near-peer facilitation, the clinical relevance of scenarios, and the psychologically safe learning environment that near-peer educators provided. Conclusions A peer-led acute-care simulation course significantly improved both knowledge and confidence among preclinical medical students. The findings suggest that vertically integrated, near-peer SBME can bridge the gap between theory and clinical practice, preparing students for acute-care responsibilities earlier in training. While immediate gains were clear, further longitudinal research is needed to assess retention, scalability, and comparative effectiveness versus faculty-led approaches.