Hip fractures in the elderly are common and prevalent, so I bring you the hip fracture treatment guidelines adopted by the American Academy of Orthopaedic Surgery in 2014 to share with you.
Advanced imaging
Further MRI should be performed in cases of suspected hip fracture when initial x-ray does not show abnormalities.
Recommended intensity: moderate
Preoperative regional analgesia
Regional analgesia can improve preoperative pain in hip fracture patients
Recommended intensity: strong
Preoperative traction
Preoperative traction is not supported routinely in cases of hip fracture
Recommended intensity: moderate
Timing of surgery
Surgery within 48 hours of admission for hip fractures is associated with a better outcome
Recommended intensity: moderate
Aspirin and clopidogrel
No delay in surgery for hip fractures in patients taking aspirin and/or clopidogrel
Recommended intensity: limited
Anesthesia
Similar results with general or spinal anesthesia in patients undergoing hip fracture surgery
Recommended intensity: strong
Stable femoral neck fracture
Stable (non-displaced) femoral neck fractures should be surgically fixed internally
Recommended intensity: Moderate
Displaced femoral neck fractures
Unstable (displaced) femoral neck fractures should be replaced with an artificial joint
Recommended intensity: strong
Unipolar or bipolar
Unipolar and bipolar artificial femoral head replacements are similar in the treatment of unstable (displaced) femoral neck fractures
Recommended strength: moderate
Semipolar or total hip
Total hip replacement is preferable in suitable patients with unstable (displaced) femoral neck fractures
Recommended strength: medium
Cemented femoral stem
Cemented femoral stems are preferred in patients with femoral neck fractures for arthroplasty
Recommended strength: medium
Surgical Approach
The posterior approach for hip replacement in displaced femoral neck fractures has a higher rate of dislocation
Recommended strength: medium
Stable intertrochanteric fracture
Stable intertrochanteric fractures can be treated with hip slide screws or proximal intramedullary nails
Recommended strength: medium
Subrotor fracture or reverse oblique row fracture
Proximal intramedullary nailing for subrotor fractures or anteversion fractures
Recommended strength: strong
Unstable inter-rotor fracture
Proximal intramedullary nailing for unstable intertrochanteric fractures
Recommended strength: moderate
Prevention of venous thrombosis
Prevention of venous thromboembolism is required in patients with hip fractures
Recommended intensity: moderate
Threshold for blood transfusion
The critical value of blood transfusion for asymptomatic anemia after hip fracture is less than 8 g/dl
Recommended intensity: strong
Physical functional therapy
Supervised physical function therapy throughout the recovery process, including at home, improves function and prevents falls
Recommended intensity: moderate
Intensive Physical Therapy
Intensive home physical therapy improves functional outcomes
Recommended Intensity: Intense
Nutrition
The addition of nutrition to patients with possible nutritional deficiencies may improve functional outcomes and reduce mortality, so patients should be evaluated for nutritional status.
Recommended intensity: moderate
Multidisciplinary treatment
Multidisciplinary collaboration can lead to better functional outcomes in mild to moderate dementia with hip fracture
Recommended intensity: strong
Postoperative multimodal analgesia
Postoperative multimodal analgesia for hip fracture should be performed
Recommended intensity: strong
Calcium and vitamin D
Vitamin D and calcium supplementation after hip fracture surgery
Recommended intensity: moderate
Monitoring
Preoperative monitoring of serum albumin and creatinine levels to assess the risk of hip fracture
Recommended intensity: limited
Evaluation and treatment of osteoporosis Osteoporosis should be evaluated and treated after hip fracture
Recommended intensity: moderate