Intertrochanteric Hip Fractures Guidelines

Updated: Dec 15, 2021
  • Author: James F Kellam, MD, FRCSC, FACS, FRCS(Ire); Chief Editor: William L Jaffe, MD  more...
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AAOS Guidelines for Hip Fracture in Older Adults

In December 2021, the American Academy of Orthopaedic Surgeons (AAOS) released an updated clinical practice guideline for the management of hip fractures in older adults. [19] Recommendations relevant to patients with intertrochanteric hip fractures included the following:

  • Preoperative traction should not be routinely used.
  • Better outcomes may be obtained if hip fracture surgery is done in the first 24-48 hours after admission.
  • Venous thromboembolism (VTE) prophylaxis is warranted.
  • Either spinal or general anesthesia is appropriate.
  • Patients with stable intertrochanteric fractures should be treated with either a sliding hip screw or a cephalomedullary device.
  • Patients with unstable intertrochanteric fractures should be treated with a cephalomedullary device.
  • In patients who are asymptomatic after operative treatment of hip fracture, a blood transfusion threshold no higher than 8 g/dL is suggested.
  • For treatment of pain after hip fracture, multimodal analgesia incorporating preoperative nerve block is recommended.
  • For reduction of blood loss and blood transfusion, tranexamic acid should be administered.
  • To decrease complications and improve outcomes, interdisciplinary care programs should be implemented.