Management of Post-Fall Hip Injuries in the Elderly

Diagnostic Approach

Plain radiographs are mandatory first-line imaging, despite the presence of only bruising, as displaced fractures may present with deceptively mild external findings in elderly patients 1
If plain films are normal but clinical suspicion remains high, proceed immediately to CT hip without IV contrast, which has 94% sensitivity and 100% specificity for occult fractures 1
Do not rely on preserved range of motion or ability to bear weight to exclude fracture—patients with minimally displaced fractures can maintain function initially 2

Complete blood count to assess for anemia from blood loss and leucocytosis indicating infection 3
Comprehensive metabolic panel including electrolytes and renal function 3
ECG in all elderly hip trauma patients to identify cardiac abnormalities 3
Coagulation studies if anticoagulation therapy is present or surgery is anticipated 4

Surgery within 24-48 hours of admission significantly reduces short-term and mid-term mortality rates and complications from immobility 4, 3
Immediate adequate pain relief using nerve blocks, which reduce acute pain more effectively than systemic analgesia alone 4
Appropriate fluid management to correct hypovolemia, which is common in elderly fracture patients 5
Multidisciplinary assessment including geriatric evaluation for malnutrition, cardiac/pulmonary disease, and cognitive function 5, 4

Orthogeriatric comanagement on a dedicated ward improves functional outcomes, reduces length of stay, and lowers 1-year mortality 4, 6
Continue regular paracetamol augmented by carefully prescribed opioid analgesia as needed 5
Supplemental oxygen for at least 24 hours postoperatively, as older patients are at high risk of hypoxia 5
Early mobilization with weight-bearing as tolerated to prevent complications and promote recovery 3

Comprehensive rehabilitation program coordinated by orthogeriatricians, including physiotherapy, occupational therapy, and social work support 5
Referral to Fracture Liaison Service for secondary fracture prevention 3
Bisphosphonate therapy to reduce risk of subsequent fractures 5, 3
Adequate calcium intake and vitamin D supplementation 3
Weight-bearing impact exercise and resistance training to promote bone health 3
Multifactorial fall prevention strategies including balance training 6, 3

Allow weight-bearing as tolerated with assistive device for 2-3 weeks while monitoring for clinical deterioration, as occult fractures can present with delayed symptoms 2
Analgesia with regular paracetamol and judicious opioid use for severe pain 5
Early gentle range-of-motion exercises after initial pain subsides at 3-5 days 2
Do not prescribe complete bed rest, as immobility increases complications including pneumonia, pressure ulcers, and deconditioning 5, 2