Last updated December 18, 2021

Management of Hip Fractures in Older Adults

RECOMMENDATIONS

PREOPERATIVE TRACTION

Moderate evidence does not support routine use of preoperative traction for patients with a hip fracture. (S)
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SURGICAL TIMING

Hip fracture surgery within 24-48 hours of admission may be associated with better outcomes.
 
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VTE PROPHYLAXIS

Venous thromboembolism (VTE) prophylaxis should be used in hip fracture patients.
 
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ANESTHESIA

Either spinal or general anesthesia is appropriate for patients with a hip fracture.
 
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ARTHROPLASTY VS. FIXATION

In patients with unstable (displaced) femoral neck fractures, arthroplasty is recommended over fixation.
 
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UNIPOLAR/BIPOLAR HEMIARTHROPLASTY

In patients with unstable (displaced) femoral neck fractures, unipolar or bipolar hemiarthroplasty can be equally beneficial.
 
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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.
 
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CEMENTED FEMORAL STEMS

In patients undergoing arthroplasty for femoral neck fractures, the use of cemented femoral stems is recommended.
 
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SURGICAL APPROACH

In patients undergoing treatment of femoral neck fractures with hip arthroplasty, evidence does not show a favored surgical approach.
 
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STABLE INTERTROCHANTERIC FRACTURES

In patients with stable intertrochanteric fractures, use of either a sliding hip screw or a cephalomedullary device is recommended.
 
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SUBTROCHANTERIC OR REVERSE OBLIQUITY FRACTURES

In patients with subtrochanteric or reverse obliquity fractures a cephalomedullary device is recommended.
 
 
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UNSTABLE INTERTROCHANTERIC FRACTURES

Patients with unstable intertrochanteric fractures should be treated with a cephalomedullary device.
 
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TRANSFUSION

A blood transfusion threshold of no higher than 8g/dl is suggested in asymptomatic postoperative hip fracture patients.
 
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MULTIMODAL ANALGESIA

Multimodal analgesia incorporating preoperative nerve block is recommended to treat pain after hip fracture.
 
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TRANEXAMIC ACID

Tranexamic acid should be administered to reduce blood loss and blood transfusion in patients with hip fractures.
 
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INTERDISCIPLINARY CARE PROGRAMS

Interdisciplinary care programs should be used in the care of hip fracture patients to decrease complications and improve outcomes.
 
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STABLE FEMORAL NECK FRACTURES

In patients with stable (impacted/non-displaced) femoral neck fractures, hemiarthroplasty, internal fixation or non-operative care may be considered.
 
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PERTROCHANTERIC FRACTURES

In patients with pertrochanteric femur fractures, short or long cephalomedullary nail may be considered.
 
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WEIGHT BEARING

Following surgical treatment of hip fractures, immediate, full weight bearing to tolerance may be considered.
 
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Recommendation Grading

Overview

Title

Management of Hip Fractures in Older Adults

Authoring Organization

Publication Month/Year

December 3, 2021

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Target Provider Population

Geriatrician; Anesthesiologist

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

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.