Management of proximal femoral fractures 2011

Abstract

Summary 1. There should be protocol‐driven, fast‐track admission of patients with hip fractures through the emergency department. 2. Patients with hip fractures require multidisciplinary care, led by orthogeriatricians. 3. Surgery is the best analgesic for hip fractures. 4. Surgical repair of hip fractures should occur within 48 hours of hospital admission. 5. Surgery and anaesthesia must be undertaken by appropriately experienced surgeons and anaesthetists. 6. There must be high‐quality communication between clinicians and allied health professionals. 7. Early mobilisation is a key part of the management of patients with hip fractures. 8. Pre‐operative management should include consideration of planning for discharge from hospital. 9. Measures should be taken to prevent secondary falls. 10. Continuous audit and targeted research is required in order to inform and improve the management of patients with hip fracture.

The inpatient fracture neck of femur: An important subgroup of patients

“…Nationally, 30-day mortality is quoted at 8.1% in 2012-2013, with 86% of patients receiving surgery within 48 h [1][2][3]. In our study, we found that patients with a FNOF from the community closely matched these figures with regard to 30-day mortality (10.4%) and operative management within 48 h of presentation (88.4%).…”

“…Patients suffering this injury commonly pose a challenge medically as 17% of patients are noted to have two major co-morbidities and 7% have three or more [2].…”

“…Subsequent guidelines published by the National Institute for Clinical Excellence (NICE) [6] and Association of Anaesthetists of Great Britain and Ireland [2] aim to improve the care of patients with an acute FNOF. These guidelines however focus on the care of patients who have fallen within the community with little specific guidance for patients who have fallen and sustained an injury within a hospital.…”

Summary of Clinical Guidelines for the Diagnosis and Treatment of Osteoporosis of the Russian Association of Endocrinologists

“…РЕКОМЕНДАЦИЯ 16: Всем пациентам с низко-травматическим переломом бедра рекомендуется хирур-гическое лечение у травматолога-ортопеда в течение 48 часов с последующей активизацией пациента [115][116][117].…”

Ultrasound‑guided continuous fascia iliaca compartment block for pre‑operative pain control in very elderly patients with hip fracture: A randomized controlled trial

“…Despite remarkable benefits of early surgery following hip fracture on outcomes and elderly patients exhibit numerous complications. The most common coexisting diseases include cardiovascular disease (35%), respiratory disease (14%) and cerebrovascular disease (13%), and ~70% of patients are classified as American Society of Anesthesiologists (ASA) stage III or IV (10) in poor health and time to surgery is prolonged due to direct oral anticoagulants and other factors, including waiting for routine medical clearance and unavailability of the operating suite or surgeon (11,12). In China, very elderly are frequently defined as ≥80 years old patients, and it has been estimated that the lifetime risk for an 80-year-old man or woman to sustain a hip fracture is 9 and 19%, respectively (13).…”