While there is no doubt about the importance of early operation of fractures of the proximal femur in the very old the exact timing of the operation is still in discussion. Routine emergency operation is opposed to a carefully planned individual timing of surgery. The advantages of a medical and anesthesiological pretreatment could be clearly demonstrated in an own series of 107 patients older than 85 treated for fracture of the proximal femur in the last three years. Hospital mortality was lowered from 18.9 to 9.1%. At the same time the rate of severe complications and the length of hospital stay were reduced significantly.
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