Prevalence and preventive strategies for pressure ulcers in acute hip fracture patients: a systematic review

Abstract

Hip fractures are a major cause of morbidity and mortality among older adults and frequently require hospitalization and surgical intervention. Patients with hip fractures are particularly vulnerable to pressure ulcers due to immobility, frailty, and comorbidities. This systematic review evaluated the prevalence of pressure ulcers following hip fracture and examined perioperative factors associated with their development. A systematic review was conducted in accordance with PRISMA guidelines. Ovid MEDLINE, Embase, and Ovid Emcare were searched from inception to May 24, 2025. Studies including patients with hip fractures reporting pressure ulcer outcomes were eligible. Randomized controlled trials, cohort studies, and case series with ≥10 patients were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria and the Joanna Briggs Institute (JBI) critical appraisal checklist. Given anticipated heterogeneity, pressure ulcer prevalence was summarized descriptively using study-level medians, interquartile ranges (IQR), and ranges. Subgroup analyses were performed according to mattress type, nutritional status, surgical procedure, and timing of surgery. Eighty-two studies comprising 63,921 patients were included. The median reported patient age was 81 years. Across all studies, the median pressure ulcer prevalence was 8.0% (IQR 3.4–14.6%), with reported rates ranging from 0.2% to 55.3%. Among studies reporting numerator and denominator data, 5,272 pressure ulcers occurred among 63,438 patients, corresponding to a crude pooled proportion of 8.3%. Pressure-relieving mattresses demonstrated lower median ulcer rates compared with standard mattresses (8.7% vs 20.1%). Arthroplasty cohorts demonstrated lower median ulcer prevalence than internal fixation cohorts (3.6% vs 6.5%). Earlier surgical intervention (≤48 hours) demonstrated slightly lower pressure ulcer rates than delayed surgery, although substantial subgroup heterogeneity was present. Methodological quality was generally moderate across studies. Pressure ulcers remain a common complication following hip fracture, with a median reported prevalence of approximately 8%. Potentially modifiable perioperative factors, including support surface selection and timely surgery, may influence pressure ulcer risk, although substantial heterogeneity exists across the literature. Further prospective studies with standardized outcome reporting are needed to better define prevention strategies in hip fracture populations. IV, systematic review Not applicable.