ReviewHealth science reports2026
Hip Fracture Management in Older Adults in Resource-Constrained Settings: Determinants, Care Pathways, and Outcomes-A Systematic Review and Meta-Analysis.
Review in Health science reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background and Aims: Hip fractures in older adults cause substantial mortality and functional decline, particularly where access to timely surgery is limited. This review synthesized the determinants, management pathways, and outcomes of hip fractures in resource-constrained settings and evaluated the association between non-operative management (NOM) and mortality. Methods: PubMed, Scopus, and Web of Science were searched from January 1, 2015, to January 25, 2026. Eligible studies included older adults with hip fractures managed in resource-constrained settings and reported management determinants, care pathways, or clinical outcomes. Study selection and reporting followed PRISMA 2020 and MOOSE recommendations. Mortality comparing NOM with operative management was pooled using a random-effects model. Risk of bias and certainty of evidence were assessed using design-appropriate tools and a GRADE-informed approach. Results: Fourteen studies were included. NOM prevalence ranged from approximately 10% to more than 30%. Selection of NOM and delayed surgery reflected patient factors, including advanced age, frailty, comorbidity, impaired premorbid mobility, and cognitive impairment, alongside system constraints such as out-of-pocket costs, limited theater capacity, workforce and implant shortages, and delayed referral. Three LMIC/UMIC cohort studies contributed to the mortality meta-analysis. NOM was associated with higher mortality than operative management (RR 2.76, 95% CI 1.14-6.70), with substantial heterogeneity (I Conclusion: NOM and delayed hip fracture care reflect both clinical vulnerability and health-system constraints. Although NOM was associated with higher mortality, the limited observational evidence, substantial heterogeneity, and confounding by indication preclude causal interpretation. Strengthening financing, referral pathways, surgical capacity, implant availability, and perioperative care may improve equitable access to timely treatment.
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