Post-Operative Care Protocol for Femur Fracture Status Post Cephalomedullary Nail

Immediate Post-Operative Management

Patients should be allowed to weight-bear as tolerated immediately after cephalomedullary nail fixation, regardless of fracture pattern, as recommended by the American Academy of Orthopaedic Surgeons 1, 2
Multimodal analgesia incorporating a preoperative nerve block is strongly recommended and should continue into the immediate post-operative period, according to the American Academy of Orthopaedic Surgeons 1
Regular paracetamol administration is recommended, avoiding NSAIDs in elderly patients with renal dysfunction, as suggested by Anaesthesia 3
Pain evaluation should be included as part of routine nursing observations, as recommended by Anaesthesia 3
Administer supplemental oxygen for at least 24 hours post-operatively, as older patients are at high risk of hypoxia, according to Anaesthesia 3
Oxygenation improves with early mobilization, as stated by Anaesthesia 3
Encourage early oral fluid intake rather than routine IV fluids, as recommended by Anaesthesia 3
Monitor for hypovolemia, which is common in these patients, according to Anaesthesia 3
For symptomatic anemia, transfuse packed red blood cells, as recommended by the American Academy of Orthopaedic Surgeons 2
Remove urinary catheters as soon as possible to reduce infection risk, as suggested by Anaesthesia 3

Administer pharmacologic VTE prophylaxis for at least 4 weeks post-operatively, in addition to sequential compression devices during hospitalization, as recommended by the American Academy of Orthopaedic Surgeons 1, 2

Full weight-bearing as tolerated should begin immediately post-operatively for all cephalomedullary nail fixations, including stable intertrochanteric fractures, unstable intertrochanteric fractures, subtrochanteric fractures, and reverse obliquity fractures, according to the American Academy of Orthopaedic Surgeons 1, 2

Interdisciplinary care programs involving orthogeriatrics, physical therapy, occupational therapy, and nursing should be implemented to decrease complications and improve outcomes, as recommended by the American Academy of Orthopaedic Surgeons and Anaesthesia 1, 3
Ward care should maintain a nurse-to-patient ratio of 1:4, as suggested by Anaesthesia 3
Regular physician input from geriatric medicine specialists is recommended, according to Anaesthesia 3
Dietetic support is necessary, as up to 60% of hip fracture patients are malnourished on admission, as stated by Anaesthesia 3
Nutritional supplementation reduces mortality and may decrease length of stay, according to Anaesthesia 3

Optimize analgesia, nutrition, hydration, and electrolyte balance to prevent cognitive dysfunction, as recommended by Anaesthesia 3
Identify and treat silent complications, such as chest infection, myocardial ischemia, and urinary tract infection, according to Anaesthesia 3
Use haloperidol or lorazepam only for short-term symptom control, as suggested by Anaesthesia 3
Avoid cyclizine due to antimuscarinic effects in elderly patients, according to Anaesthesia 3
Draw vitamin D, calcium, and parathyroid hormone levels during hospitalization, as recommended by the American Academy of Orthopaedic Surgeons 2
Order outpatient DEXA scan, according to the American Academy of Orthopaedic Surgeons 2
Refer to bone health clinic for osteoporosis management, as recommended by the American Academy of Orthopaedic Surgeons 2
Implement fall prevention strategies through education and environmental modification, as suggested by Praxis Medical Insights 4

Do not use preoperative traction for hip fracture patients, as this is strongly contraindicated, according to the American Academy of Orthopaedic Surgeons 2
Do not restrict weight-bearing based on fracture pattern, as cephalomedullary nails provide sufficient stability for immediate full weight-bearing, as recommended by the American Academy of Orthopaedic Surgeons 1, 2
Do not delay mobilization, as prolonged bed rest increases complications and mortality, according to Anaesthesia 3