Management of Hip Fractures in Older Adults
Publication Date: December 3, 2021
Last Updated: March 14, 2022
RECOMMENDATIONS
PREOPERATIVE TRACTION
Moderate evidence does not support routine use of preoperative traction for patients with a hip fracture. (S)
312070
SURGICAL TIMING
Hip fracture surgery within 24-48 hours of admission may be associated with better outcomes. (M)
312070
VTE PROPHYLAXIS
Venous thromboembolism (VTE) prophylaxis should be used in hip fracture patients. (S)
312070
ANESTHESIA
Either spinal or general anesthesia is appropriate for patients with a hip fracture. (S)
312070
ARTHROPLASTY VS. FIXATION
In patients with unstable (displaced) femoral neck fractures, arthroplasty is recommended over fixation. (S)
312070
UNIPOLAR/BIPOLAR HEMIARTHROPLASTY
In patients with unstable (displaced) femoral neck fractures, unipolar or bipolar hemiarthroplasty can be equally beneficial. (M)
312070
TOTAL ARTHROPLASTY VS. HEMI ARTHROPLASTY
In properly selected patients with unstable (displaced) femoral neck fractures, there may be a functional benefit to total hip arthroplasty over hemi arthroplasty at the risk of increasing complications. (M)
312070
CEMENTED FEMORAL STEMS
In patients undergoing arthroplasty for femoral neck fractures, the use of cemented femoral stems is recommended. (S)
312070
SURGICAL APPROACH
In patients undergoing treatment of femoral neck fractures with hip arthroplasty, evidence does not show a favored surgical approach. (M)
312070
STABLE INTERTROCHANTERIC FRACTURES
In patients with stable intertrochanteric fractures, use of either a sliding hip screw or a cephalomedullary device is recommended. (S)
312070
SUBTROCHANTERIC OR REVERSE OBLIQUITY FRACTURES
In patients with subtrochanteric or reverse obliquity fractures a cephalomedullary device is recommended. (S)
312070
UNSTABLE INTERTROCHANTERIC FRACTURES
Patients with unstable intertrochanteric fractures should be treated with a cephalomedullary device. (S)
312070
TRANSFUSION
A blood transfusion threshold of no higher than 8g/dl is suggested in asymptomatic postoperative hip fracture patients. (M)
312070
MULTIMODAL ANALGESIA
Multimodal analgesia incorporating preoperative nerve block is recommended to treat pain after hip fracture. (S)
312070
TRANEXAMIC ACID
Tranexamic acid should be administered to reduce blood loss and blood transfusion in patients with hip fractures. (S)
312070
INTERDISCIPLINARY CARE PROGRAMS
Interdisciplinary care programs should be used in the care of hip fracture patients to decrease complications and improve outcomes. (S)
312070
STABLE FEMORAL NECK FRACTURES
In patients with stable (impacted/non-displaced) femoral neck fractures, hemiarthroplasty, internal fixation or non-operative care may be considered. (L)
312070
PERTROCHANTERIC FRACTURES
In patients with pertrochanteric femur fractures, short or long cephalomedullary nail may be considered. (L)
312070
WEIGHT BEARING
Following surgical treatment of hip fractures, immediate, full weight bearing to tolerance may be considered. (L)
312070
Title
Management of Hip Fractures in Older Adults
Authoring Organization
American Academy of Orthopaedic Surgeons
Publication Month/Year
December 3, 2021
Last Updated Month/Year
February 9, 2024
External Publication Status
Published
Country of Publication
US
Target Patient Population
Elderly patients with hip fractures
Target Provider Population
Orthopedic Surgeons, Geriatricians; Anesthesiologists and other allied providers
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Home health, Hospital, Long term care, Outpatient, Operating and recovery room
Intended Users
Dietician nutritionist, occupational therapist, physical therapist, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Treatment, Management, Prevention, Rehabilitation
Diseases/Conditions (MeSH)
D010024 - Osteoporosis, D058866 - Osteoporotic Fractures
Keywords
osteoporosis, elderly, fall prevention, geriatric falls, hip fracture, Osteoporosis
Source Citation
American Academy of Orthopaedic Surgeons Management of Hip Fractures in Older Adults Evidence-Based Clinical Practice Guideline. https://www.aaos.org/hipfxcpg.pdf Published December 3, 2021.
Methodology
Number of Source Documents
231
Literature Search Start Date
March 1, 2020
Literature Search End Date
July 1, 2021