AAOS Guidelines for Hip Fractures 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.^[20]Recommendations relevant to patients with subtrochanteric 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.
Prophylaxis for venous thromboembolism (VTE) is warranted.
Either spinal or general anesthesia is appropriate.
In patients with subtrochanteric or reverse obliquity fractures, a cephalomedullary device is recommended.
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.

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Media Gallery

Injury radiograph of high-energy intertrochanteric fracture with reverse obliquity.
Subtrochanteric fracture repaired with cephalomedullary nail.
The Seinsheimer classification of subtrochanteric femur fractures.
The Arbeitsgemeinschaft für osteosynthesefragen–Association for the Study of Internal Fixation (AO-ASIF) classification of subtrochanteric femur fractures.
The Russell-Taylor classification of subtrochanteric femur fractures.
Reverse obliquity subtrochanteric femur fracture malreduced with a short cephalomedullary nail
Subtrochanteric femur fracture reduction revised and stabilized with a blade plate. Patient went on to heal and return to full function without pain.
Subtrochanteric femur fracture repaired with cephalomedullary device

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Author

Mark A Lee, MD Associate Professor, Director of Orthopedic Trauma Fellowship, Department of Orthopedic Surgery, University of California at Davis School of Medicine

Mark A Lee, MD is a member of the following medical societies: Orthopaedic Trauma Association, AO Foundation

Disclosure: Received grant/research funds from Synthes, USA for none; Received honoraria from Synthes, USA for speaking and teaching; Received consulting fee from Biomet, USA for consulting; Received consulting fee from Zimmer, USA for speaking and teaching; Received grant/research funds from Spinesmith for none.

Coauthor(s)

David A Forsh, MD Chief, Orthopedic Trauma Surgery, Assistant Professor, Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai

David A Forsh, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, AO North America

Disclosure: Nothing to disclose.

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

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.

B Sonny Bal, MD, JD, PhD, MBA CEO and President, SINTX Technologies, Salt Lake City, UT

B Sonny Bal, MD, JD, PhD, MBA is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: SINTX Technologies.

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.

Additional Contributors

Steven I Rabin, MD, FAAOS Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Musculoskeletal Services, Dreyer Medical Clinic

Steven I Rabin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Fracture Association, American Orthopaedic Association, AO Foundation, Chicago Metropolitan Trauma Society, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society, Mid-America Orthopaedic Association, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Subtrochanteric Hip Fractures Guidelines

AAOS Guidelines for Hip Fractures in Older Adults

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