Hip fractures in healthy patients: operative delay versus prognosis.

Villar, Richard; Allen, Sian; Barnes, Sarah J.

doi:10.1136/bmj.293.6556.1203

Cited by 100 publications

(44 citation statements)

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“…Generally, surgical management of proximal femur fractures is considered standard treatment [7,23,43,55,62,100,135,[138][139][140]202]. There is no evidence from randomized studies regarding the timing of fracture management; and observational studies have reached various conclusions [22,45,70,140,194]. Early operative management (within 24-36 hours) after physiological stabilization is recommended for most patients.…”

Section: Explanationmentioning

confidence: 99%

Level 3 guideline on the treatment of patients with severe/multiple injuries

Bouillon¹,

Pieper²,

Flohé³

et al. 2018

Eur J Trauma Emerg Surg

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Section: Explanationmentioning

confidence: 99%

Level 3 guideline on the treatment of patients with severe/multiple injuries

Bouillon¹,

Pieper²,

Flohé³

et al. 2018

Eur J Trauma Emerg Surg

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“…(9) While surgical intervention is expected to be the ideal treatment option (since it permits faster functional recovery), there are limited studies comparing the outcomes of surgical and non-surgical treatments for hip fractures. (10)(11)(12) Tan Tock Seng Hospital (TTSH), Singapore, is a major trauma centre in which hip fractures constitute about 8% of all orthopaedic emergency admissions. Clinical data on all patients who were admitted to TTSH with hip fractures has been entered into a hip fracture registry since the year 2000.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes and hospital length of stay in 2,756 elderly patients with hip fractures: a comparison of surgical and non-surgical management

Tan¹,

Tan²,

Jaipaul³

et al. 2017

smedj

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“…3 Current guidelines 4 indicate that surgery for hip fracture should be performed within 24 hours of injury, as earlier surgery has been associated with better functional outcome, shorter hospital stay, shorter duration of pain and lower rates of nonunion, postoperative complications and mortality. [5][6][7][8][9][10][11] Proponents of early treatment argue that this approach minimizes the length of time a patient is confined to bed rest, thereby reducing the risk of associated complications, such as pressure sores, deep vein thrombosis and urinary tract infections. 8 However, those favouring a delay believe it provides the opportunity to optimize patients' medical status, thereby decreasing the risk of perioperative complications.…”

mentioning

confidence: 99%

Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis

Simunovic¹,

Devereaux²,

Sprague³

et al. 2010

Canadian Medical Association Journal

714

473

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Background: Guidelines exist for the surgical treatment of hip fracture, but the effect of early surgery on mortality and other outcomes that are important for patients remains unclear. We conducted a systematic review and meta-analysis to determine the effect of early surgery on the risk of death and common postoperative complications among elderly patients with hip fracture. Methods:We searched electronic databases (including MEDLINE and EMBASE), the archives of meetings of orthopedic associations and the bibliographies of relevant articles and questioned experts to identify prospective studies, published in any language, that evaluated the effects of early surgery in patients undergoing procedures for hip fracture. Two reviewers independently assessed methodologic quality and extracted relevant data. We pooled data by means of the DerSimonian and Laird random-effects model, which is based on the inverse variance method. Results:We identified 1939 citations, of which 16 observational studies met our inclusion criteria. These studies had a total of 13 478 patients for whom mortality data were complete (1764 total deaths). Based on the five studies that reported adjusted risk of death (4208 patients, 721 deaths), irrespective of the cut-off for delay (24, 48 or 72 hours), earlier surgery (i.e., within the cut-off time) was associated with a significant reduction in mortality (relative risk [RR] 0.81, 95% confidence interval [CI] 0.68-0.96, p = 0.01). Unadjusted data indicated that earlier surgery also reduced in-hospital pneumonia (RR 0.59, 95% CI 0.37-0.93, p = 0.02) and pressure sores (RR 0.48, 95% CI 0.34-0.69, p < 0.001).Interpretation: Earlier surgery was associated with a lower risk of death and lower rates of postoperative pneumonia and pressure sores among elderly patients with hip fracture. These results suggest that reducing delays may reduce mortality and complications. AbstractPreviously published at www.cmaj.ca Research Identification of studiesWe used multiple strategies to identify potentially eligible studies. With the help of a professional librarian, we searched the electronic databases MEDLINE and EMBASE for relevant articles in any language that were published up to and including Feb. 8, 2008. The complete search strategies are shown in Appendix 1 (available at www .cmaj .ca /cgi /content /full /cmaj .092220 /DC1). One reviewer (N.S.) also handsearched the archives of annual meetings of the Orthopaedic Trauma Association (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), the International Society of Orthopaedic Surgery and Traumatology (2003-2007), the Canadian Orthopaedic Association (2006)(2007), the European Federation of National Associations of Orthopaedics and Traumatology (2005-2007), the Mid-America Orthopaedic Association (2005, the Piedmont Orthopedic Society (2005Society ( -2007, the Association of Bone and Joint Surgeons (2005-2007) and the American Academy of Orthopaedic Surgeons (2006Surgeons ( -2007 for any relevant unpublished literature. Additiona...

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Hip fractures in healthy patients: operative delay versus prognosis.

Abstract: 6 World Health Organisation. defnitions, terminology and format for statistical table related to the peinatal periodand use ofa new cerdficate forcause ofperinatal deaths. Acta

Cited by 100 publications

References 0 publications

Level 3 guideline on the treatment of patients with severe/multiple injuries

Level 3 guideline on the treatment of patients with severe/multiple injuries

Clinical outcomes and hospital length of stay in 2,756 elderly patients with hip fractures: a comparison of surgical and non-surgical management

Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis

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