”Seventy do not stay overnight, eighty do not stay for dinner”, this is a popular folk saying. What does this phrase mean? It says that after people get older, as they get older, the function of the body’s organs gradually declines, and they are especially prone to accidents of one kind or another when they go out. Most common sudden accidents are cardiovascular and cerebrovascular diseases, but there are also a considerable number of fractures caused by falls, such as hip fractures. Orthopedic surgeons usually classify such fall fractures in the elderly as osteoporotic, low-energy fragility fractures. Because this patient group is older and almost always has a combination of various medical conditions, such as hypertension, coronary artery disease, diabetes, etc., it is very difficult to manage clinically, and it is a real tangle to decide whether or not to proceed with surgical treatment. I once had a friend and a patient’s family member come to me with a film and ask, “This 70- or 80-year-old man has a hip fracture and is afraid to even stay overnight for dinner, can he still receive surgery?” In response to this confusion, I summarized some small experiences in my clinical work, hoping to answer this question well: “What should elderly patients with hip fracture do? Sun Tong, Department of Orthopedics, Beijing Anzhen Hospital I. What is a hip fracture? What is a hip fracture? In the words of the common people, it is “a broken hip”. According to the location of the fracture, orthopedic surgeons will subdivide hip fractures into femoral neck fractures and intertrochanteric fractures (also called intertrochanteric fractures). This is the most common type of hip fracture in older patients. The causes of fracture include the following two main points: 1) elderly patients, with osteoporosis and increased brittleness of bone, are prone to fracture, which is an intrinsic factor; 2) falls, which can cause hip fracture with low energy and slight external force, which is an extrinsic trigger. Based on the 1990 census data, the epidemiological study on the incidence of hip fracture in Beijing showed that the incidence of hip fracture in women was only 88/100,000, while in men it was 97/100,000, which was not a high incidence at that time. However, according to a study at the Union Hospital, in the sixteen years from 1990 to 2006, the incidence of hip fracture in Beijing increased 1.61 times in men over 50 years of age and 2.76 times in women! Worldwide, approximately one osteoporotic fracture occurs every 30 seconds in people over the age of 50. The World Health Organization (WHO) predicts that by 2050 half of all hip fractures in women worldwide will occur in the Asian region. These data show that the incidence of hip fracture in the elderly is increasing year by year and the rate of growth is rapid, which should receive our extra attention. Second, the danger of hip fracture? Elderly patients with hip fracture are often unable to walk on the ground due to pain and limb dysfunction, and can only stay in bed. If they are bedridden for a long time and do not pay attention to strengthening care (or their families are not very good at care), some complications will follow, such as bed sores, crushing pneumonia and venous thrombosis of the lower limbs. These complications are the biggest and most serious hazards that hip fracture brings to patients. The fracture itself is not terrible, but the various complications caused by the fracture can be fatal! In many elderly patients, the cause of death is not a brain attack or a heart attack or other medical disease, but a complication after a hip fracture. For this reason, hip fractures were often referred to as the “last fracture of life” in the past. The meaning is, once the elderly fracture, life is in danger! Third, what to do with hip fracture? What should the elderly hip fracture patients do? First of all, I would like to talk about active surgical treatment. Usually, the explanatory articles about the diagnosis and treatment of the disease will put conservative treatment in the front, which seems to be more in line with the common sense and the principle of treatment. However, hip fracture is a special case, and conservative treatment means that elderly patients need to be bedridden for a long time. And what is this long-term concept? In the words of a common saying, “It takes 100 days to break a bone”! That is, three months of bed rest. Three months in bed, and care measures can not keep up, pneumonia, bedsores and other complications, “the last fracture of life” can be fatal. Therefore, if an elderly patient has stable medical diseases, and the function of important organs such as heart, lungs and kidneys is satisfactory and can tolerate surgery, then the patient can be active and on the ground early after surgery, and the result is definitely better than conservative treatment. For elderly patients with hip fractures, preoperative evaluation is very important, and it is the guarantee of successful surgery. In a later paragraph, I will explain the importance of preoperative evaluation of hip fractures, and I will not repeat it here. The surgical approach to intertrochanteric fractures (intertrochanteric fractures) is usually a plate and screw internal fixation system or an intramedullary fixation system. Currently, the PFNA intramedullary system used in clinical practice provides immediate stability to the fracture. In the case of femoral neck fractures, cemented or biologic joint prostheses are often used for hip replacement, and the surgical results are very satisfactory. If the patient’s preoperative evaluation determines that he or she cannot tolerate surgical treatment, then conservative treatment in bed becomes the “easy way out”. It is especially important to enhance patient care to avoid fracture complications. Pre-operative evaluation of hip fracture patients Still back to the question at the beginning of the article, what should elderly hip fracture patients do and whether they can receive surgical treatment? This requires an accurate assessment of the patient’s general condition, physical condition, heart and lung conditions, etc. The Department of Orthopedics of Beijing Anzhen Hospital, with the support and assistance of the hospital’s Department of Anesthesiology, has admitted many patients with hip fractures who were transferred from outside hospitals. These patients were either post cardiac stenting or post cardiac bypass or valve replacement, all of whom had been taking anticoagulants for a long time and had relatively poor cardiac function. Those patients who were evaluated preoperatively to be able to tolerate the surgery were all very satisfied with the surgical results, and the surgical treatment greatly improved the quality of life of elderly hip fracture patients. As far as I can remember, the oldest hip fracture patient admitted to the orthopedic department of Anzhen Hospital was 99 years, 10 months and 12 days old. V. Postoperative treatment of hip fracture What other follow-up treatments are needed for elderly hip fracture patients after surgery? The most important point is anti-osteoporosis treatment. Anti-osteoporosis treatment is not something that can be done overnight, much less overnight. It should be a long-term persistent treatment measure, just like hypertension and coronary heart disease in internal medicine. Some patients often have a misconception that they have already fractured their bones anyway, and that osteoporosis cannot be cured, so it is useless to treat it again. This view needs to be corrected. The purpose of treating osteoporosis is to prevent the occurrence of fractures, especially for those patients who have already experienced a hip fracture and need to prevent the occurrence of another fracture. Treatment of osteoporosis The guidelines are based on calcium and active D with the addition of anti-osteoporosis drugs such as bisphosphonates and calcitriol, a subject I will cover in the article on osteoporosis. Finally, there is another very important point that must be emphasized for elderly patients with hip fractures, which is to prevent falls from occurring. In conclusion, elderly patients with hip fractures, due to their older age and more medical comorbidities, will certainly have a corresponding increase in surgical risk. Therefore, a comprehensive preoperative evaluation is particularly important, and it is a guarantee for the success of the surgery. If the preoperative assessment can tolerate surgery, what should elderly hip fracture patients do? The answer is surgical treatment. The quality of life of the patient will be significantly improved after surgery, which is in line with the saying: the most beautiful sunset!