Subtrochanteric Hip Fractures Guidelines

Updated: Dec 15, 2021
  • Author: Mark A Lee, MD; Chief Editor: William L Jaffe, MD  more...
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Guidelines

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.