BACKGROUND: Traumatic fractures are common in sub-Saharan Africa, a region with a shortfall of orthopaedic surgeons, and can result in morbidity if not appropriately managed. WhatsApp is an encrypted smartphone application and ubiquitous in sub-Saharan Africa. The objective of this study was to assess the use of WhatsApp as a mobile health platform to support fracture management by non-orthopaedic doctors in Cape Town, South Africa. STUDY DESIGN: A WhatsApp orthopaedic referral group was created between non-orthopaedic doctors from community health clinics and the orthopaedic team from a first-level hospital to manage traumatic fractures. Non-orthopaedic doctors posted cases on the orthopaedic referral group and the orthopaedic team provided advice. Traumatic fracture data from January 1 to June 30, 2018 were analyzed and outcomes included response time, management advice, and treatment by facility level.

Fragility fractures of the hip (FFH) constitute the most serious complication of osteoporosis, carrying a mortality rate of up to 30% in the first year after injury. Less than 50% of affected patients will regain their pre-injury activity level.Surgical fixation of the hip fracture within 48 hours of injury, multimodal pain management, deep vein thrombo-prophylaxis, early physical therapy and simultaneous management of osteoporosis and frailty in a multidisciplinary approach constitute the standard of care for FFH to keep the mortality and morbidity rates as low as possible and prevent future fragility fractures. Aim:To assess the standard of care of FFH at our institution and determine areas of management which require more attention and improvement.methods: A retrospective review of clinical and radiographic records of all patients admitted at our institution for FFH from 1 January 2014 to 31 December 2014.The waiting time from admission to surgical fixation of the hip fracture, pain control and thrombo-prophylaxis strategies, rate of geriatric referrals and extent of osteoporosis management were assessed. Results:One-hundred-and-thirteen FFH were admitted from 1 January to 31 December 2014; 98 clinical records and 98 pelvis radiographs were included in the study. The other 15 clinical records were incomplete and were therefore excluded.The average waiting time from admission to surgery was 49 hours (range 9-120). All patients received low dose morphine, paracetamol and tramadol for perioperative pain control. Low molecular weight heparin and compression stockings were prescribed for thrombo-prophylaxis in all patients.Only two (2.04%) patients had some osteoporosis investigations ordered and none of the patients were referred to the geriatric department, and none were formally treated for osteoporosis. Conclusion:While the waiting time from admission to surgery was largely within the recommended time frame, there were no signs of a multidisciplinary approach to the management of FFH at our institution, leaving osteoporosis and frailty largely untreated.Key words: fragility fractures, hip, geriatric hip fractures, standard of care for hip fractures, osteoporosis, frailty care

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