Surgical Management of Hip Fractures

Types of Hip Fractures and Appropriate Surgical Interventions

The American Academy of Orthopaedic Surgeons recommends total hip arthroplasty (THA) for displaced femoral neck fractures in healthy, active, independent older individuals without cognitive dysfunction 1, 2
The American Academy of Orthopaedic Surgeons suggests hemiarthroplasty for displaced femoral neck fractures in frail patients due to shorter operative time and lower dislocation risk 1
The American Academy of Orthopaedic Surgeons notes that THA may offer improved function over hemiarthroplasty but comes with increased risk of complications 2, 3
The American College of Rheumatology recommends cannulated fixation in a percutaneous manner for stable/non-displaced femoral neck fractures 1
The American Academy of Orthopaedic Surgeons favors sliding hip screw for stable intertrochanteric fractures 1
The American Academy of Orthopaedic Surgeons recommends antegrade cephalomedullary nail for unstable intertrochanteric fractures 1
The American College of Rheumatology supports using cephalomedullary devices for subtrochanteric or reverse oblique fractures 1

The American Academy of Orthopaedic Surgeons recommends surgery within 24-48 hours of hospital admission 3, 4
The American Academy of Orthopaedic Surgeons suggests improved outcomes with surgery within 24 hours at high-volume centers with dedicated hip fracture programs 3, 5
The Association of Anaesthetists of Great Britain and Ireland states that "surgery is the best analgesic for hip fractures" 6, 7

The American Academy of Orthopaedic Surgeons strongly recommends using cemented femoral stems in arthroplasty for hip fractures 2, 3
The American Academy of Orthopaedic Surgeons notes that cemented stems may increase surgical time and blood loss 3
The American Academy of Orthopaedic Surgeons states that surgical approach (anterior, lateral, or posterior) does not significantly affect outcomes in hip fracture arthroplasty 3

The American Academy of Orthopaedic Surgeons strongly recommends multimodal analgesia incorporating preoperative nerve blocks 2
The American Academy of Orthopaedic Surgeons suggests administering tranexamic acid to reduce blood loss and blood transfusion requirements 2
The American Academy of Orthopaedic Surgeons recommends using interdisciplinary care programs to decrease complications and improve outcomes 2, 6

The Association of Anaesthetists of Great Britain and Ireland recommends early mobilization as a key part of management 6, 7
The American College of Rheumatology suggests early post-fracture introduction of physical training and muscle strengthening 8, 9
The American College of Rheumatology recommends long-term continuation of balance training and multidimensional fall prevention 8, 9

The American Academy of Orthopaedic Surgeons notes that venous thromboembolism is a key complication to monitor 5