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.

Questions

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Media Gallery

Normal femur anatomy.
Femur with plate and screws.
Femur with intramedullary rod and screw.
Stable intertrochanteric fracture.
Unstable intertrochanteric fracture.
Intertrochanteric fracture with Enders nail.

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Author

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

James J McCarthy, MD, FAAOS, FAAP Director, Division of Orthopedic Surgery, Cincinnati Children's Hospital; Professor, Department of Orthopedic Surgery, University of Cincinnati College of Medicine

James J McCarthy, MD, FAAOS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Orthopaedic Association, Pennsylvania Medical Society, Philadelphia County Medical Society, Pennsylvania Orthopaedic Society, Pediatric Orthopaedic Society of North America, Orthopaedics Overseas, Limb Lengthening and Reconstruction Society, Alpha Omega Alpha, American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Orthopediatrics, Phillips Healthcare, POSNA<br/>Serve(d) as a speaker or a member of a speakers bureau for: Synthes<br/>Received research grant from: University of Cincinnati<br/>Received royalty from Lippincott Williams and WIcins for editing textbook; Received none from POSNA for board membership; Received none from LLRS for board membership; Received consulting fee from Synthes for none.

Chief Editor

William L Jaffe, MD Clinical Professor of Orthopedic Surgery, New York University Grossman School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases

William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, Eastern Orthopaedic Association, New York Academy of Medicine

Disclosure: Received consulting fee from Stryker Orthopaedics for speaking and teaching.

Acknowledgements

Richard S Goodman, MD, JD, FAAOS Chair, Department of Surgery, SABA University Medical School; Consulting Staff, Department of Orthopedics, Long Island Jewish/North Shore University Hospital

Richard S Goodman, MD, JD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Bar Association, American College of Legal Medicine, American College of Surgeons, Arthritis Foundation, Eastern Orthopaedic Association, International College of Surgeons, Medical Society of the State of New York, and Pan American Medical Association

Disclosure: Nothing to disclose.