EVALUATION OF POST-SURGICAL MANAGEMENT OF FRAGILITY FRACTURES

257 participants were analyzed. Most participants, 90.7% (n = 233), reported that they cared for patients with fractures and 62.3% (n = 160) treated them. The most indicated treatments were vitamin D (22.6%; n = 134) and calcium supplementation (21.4%; n = 127). According to the experience of the physicians - experienced (n = 184) and residents (n = 73) - fragility fractures were more common in the routine of residents (98.6%; n = 72) than experienced physicians (87.5%; n = 161), p = 0.0115. While treatment conduction was more reported by experienced physicians (63.6%; n = 117) than residents (58.9%; n = 43), p = 0.004. More experienced orthopedists (21.4%; n = 97) indicated treatment with bisphosphates than residents (14.2%; n = 20), p = 0.0266.

Conclusion:

Although most professionals prescribe treatment after fragility fracture surgery, about 40% of professionals still do not treat it, with differences in relation to experience. In this sense, we reinforce the importance of secondary prevention in the management of fragility fractures. Level of Evidence II, Prospective comparative study.

Keywords:
Femoral Fractures; Osteoporosis; Orthopedics; Vitamin D

Variable	N	%
Region
Midwest	12	4.7%
Northeast	30	11.7%
North	13	5.1%
Southeast	156	60,7%
South	46	17.9%
Professionals
Experienced physician	184	71.6%
Resident physician	73	28.4%
Subspecialty
None	52	20.2%
Undefined	78	30.4%
Surgery (spine)	6	2.3%
Surgery (hand)	8	3.1%
Orthopedic trauma	30	11.7%
Shoulder/elbow	9	3.5%
Hip	21	8.2%
Knee	37	14.4%
Foot/ankle	11	4.3%
Sports Orthopedics	2	0.8%
Bone tumor	3	1.2%

Variable	N	%
Routine with fractures
Yes	233	90.7%
No	24	9.3%
Conducts treatment
Yes	160	62.3%
No	42	16.3%
Refers to specialist	30	11.7%
Undefined	25	9.7%
Referred Specialist
Undefined/ does not refer	228	88.7%
Endocrinologist	2	0.8%
Orthomolecular/Osteometabolic	7	2.7%
Geriatric Specialist	5	1.9%
Obstetrician and Gynecologists	3	1.2%
Other	12	4.7%

Treatment	N	%
Vitamin D Supplementation	134	22.6%
Calcium Supplementation	127	21.4%
Bisphosphonates	117	19.7%
Muscle strengthening exercise	100	16.8%
Undefined	93	15.7%
Other	13	2.2%
Hormone therapy	10	1.7%

Variable	Experienced Physician (n = 184)		Resident Physician (n = 73)		p
	N	%	N	%
Region
Southeast	107	58.2%	49	67.1%	0.2355
Others	77	41.8%	24	32.9%	0.2355

Subspecialty
None	52	28.3%	0	0.0%	< 0.0001^*
Undefined	7	3.8%	71	97.3%
Surgery	14	7.6%	0	0.0%
Orthopedic trauma	30	16.3%	0	0.0%
Shoulder/elbow	9	4.9%	0	0.0%
Hip	19	10.3%	2	2.7%
Knee	37	20.1%	0	0.0%
Foot/ankle	11	6.0%	0	0.0%
Sports Orthopedics	2	1.1%	0	0.0%
Bone tumor	3	1.6%	0	0.0%

Variable	Experienced Physician (n = 184)		Resident Physician (n = 73)		p
	N	%	N	%
Fragility fracture in the routine
Yes	161	87.5%	72	98.6%	0.0115
No	23	12.5%	1	1.4%	0.0115
Conducts treatment
Yes	117	63.6%	43	58.9%	0.004^b
No	20	10.9%	22	30.1%
Refers to specialist	23	12.5%	7	9.6%
Undefined	24	13.0%	1	1.4%
Referred Specialist
Undefined/does not refer to specialist	160	87.0%	68	93.2%	0.2314^c
Endocrinologist	1	0.5%	1	1.4%
Orthomolecular/Osteometabolic	7	3.8%	0	0.0%
Geriatric Specialist	3	1.6%	2	2.7%
Obstetrician and Gynecologists	3	1.6%	0	0.0%
Other	10	5.4%	2	2.7%

Treatment	Physician Experienced		Resident Physician		p
Treatment	n	%	n	%	p
Bisphosphonates	97	21.4%	20	14.2%	0.0266^*
Vitamin D Supplementation	98	21.6%	36	25.5%	0.8389
Calcium Supplementation	95	21.0%	32	22.7%	0.5879
Muscle strengthening exercise	81	17.9%	19	13.5%	0.0911
Undefined	64	14.1%	29	20.6%	0.7099
Other	11	2.4%	2	1.4%	0.5256
Hormone therapy	7	1.5%	3	2.1%	NS

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E-mail: actaortopedicabrasileira@uol.com.br

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[1] Correspondence:
João Carlos Pedro Filho. Rua Napoleão de Barros, 715, 1º andar, São Paulo, SP, Brazil, 04024002. joaocarlospedrofilho@gmail.com