Does timing of surgery matter in fragility hip fractures?

Abstract

The effect of delay of surgery on the geriatric hip fractures has been a subject of interest in the past two decades. While the elderly patients will not tolerate long periods of immobilization, it is still unclear how soon these surgeries need to be performed. A review of existing literature was performed to examine the effect of timing of surgery on the different outcome parameters of these patients. Although there is conflicting evidence that early surgery would improve mortality, there is widespread evidence in the literature that other outcomes including morbidity, the incidence of pressure sores, and the length of hospital stay could be improved by shortening the waiting time of hip fracture surgery. We concluded that it is beneficial to the elderly patients to receive surgical treatment as an urgent procedure as soon as the body meets the basic anesthetic requirements.

Unstable Intertrochanteric Femur Fractures: Is There a Consensus on Definition and Treatment in Germany?

“…Therefore, the study findings gave a review without taking special clinical situations into consideration. In general, intertrochanteric fracture treatment includes patients with advanced age, and other factors such as social dependence, cachexia, anemia, cognitive dysfunction, and additional comorbidities lead to a high mortality rate [7,19,29,32,42]. Despite the potential for bias, our data suggest the AO/ OTA classification is widely used in Germany (65%-88% of hospitals) and other instability criteria (lateral wall breach, detached greater trochanter, comminution of the posteromedial cortex) played a secondary role.…”

“…Since the estimates in this survey were self-reported, this may be a topic for randomized clinical multicenter studies in the future. Another explanation could be the fact that there is a low clinical and radiographic followup rate regarding these fragile patients with many comorbidities [7,19,29,32,42]. Our survey suggested only 2% of respondents would always manage unstable intertrochanteric fractures with extramedullary plate systems, although a number of studies [3,18,21,35,38] have reported no difference in the reoperation rates after treatment with an intramedullary or extramedullary device.…”

“…One possible explanation is the higher number of attending physicians on call in these facilities. There is widespread evidence in the literature [7,19,29,32,42] that morbidity, incidence of pressure sores, and length of hospital stay could be improved by shortening the waiting time of hip fracture surgery. In Germany, early surgical treatment of elderly patients with proximal femoral fracture is preferred and recommended by the guidelines of the German Traumatology Society (Deutsche Gesellschaft für Unfallchirurgie) [1].…”

“…The survey also included questions regarding hospital sizes, hospital levels in Germany [8], geographic locations, department characteristics, and number of intertrochanteric femur fractures treated per year (self-reported measures) ( Table 1). Items 1 to 3 contained questions about demographic data, Item 4 timing of surgery [1,7,29,32,42], Items 5 and 6 classification systems (including AO/OTA [30] and Evans [11]) and instability criteria [11,17,30,44], Items 7 to 10 implant selection, Items 11 to 15 surgeon, patient positioning, and estimation of surgical and radiographic screening time, Items 16 to 18 weightbearing, hospitalization time, and discharge procedure, Item 19 expected complications, Items 20 and 21 importance of cement augmentation and minimally invasive extramedullary systems [13,21,23,24,26,39], Items 22 to 24 radiographic evaluation, reoperation rate, and importance of outcome scores, Item 25 main problems in unstable intertrochanteric fracture treatment, and Item 26 willingness to participate in a multicenter study.…”

“…Third, surgeons need to determine how much time is reasonable to delay surgery to ensure these often fragile patients are in the best possible medical condition. Current guidelines recommend hip fracture surgery be performed within 24 hours of injury to achieve reduction of pain and lower complication rates [7,29,32,42].…”