Hip Fracture in Emergency Medicine Follow-up

Updated: Feb 28, 2016
  • Author: Moira Davenport, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Follow-up

Further Outpatient Care

Few patients are eligible for discharge; those who are sent home usually require prolonged bed rest.

Consultation with an orthopedist is imperative because of the variety of treatment options and preferences.

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Further Inpatient Care

Most patients should be admitted to the hospital under the care of an orthopedic surgeon. If operative repair is planned, the patient should be cleared medically by his or her primary care physician or internist.

Patients with multiple medical problems can be admitted to the primary care service with orthopedic consultation.

Patients who have sustained multiple traumas should be admitted to the trauma service or general/trauma surgeon.

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Deterrence/Prevention

The best prevention is deterrence, specifically, avoiding the risk factors (see Causes) and undertaking fall prevention in older persons. An older patient who presents after a fall should undergo a risk assessment to prevent further falls.

Calcium supplementation, bisphosphonates, parathyroid hormone, and estrogen replacement therapy may decrease the risk of hip fractures in individuals with osteoporosis.

A meta-analysis was performed to evaluate the efficacy of oral supplemental vitamin D in preventing nonvertebral and hip fractures among older individuals (65 y or older). The meta-analysis included 12 double-blind, randomized, controlled trials (RCTs) for nonvertebral fractures (n = 42,279) and 8 RCTs for hip fractures (n = 40,886) and compared oral vitamin D (with or without calcium) with either calcium alone or placebo. The results showed that nonvertebral fracture prevention with vitamin D is dose dependent, and a higher dose reduced fractures by at least 20% for individuals aged 65 years or older. [21]

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Complications

Complications include the following:

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Prognosis

Hip fracture outcomes vary considerably depending upon the patient's age, comorbidities, fracture type, and numerous other factors.

In general, young patients almost always regain the ability to ambulate, yet depending on fracture type, they may not return to their previous level of activity.

Many older patients do not regain the ability to ambulate or are able to do so only with assistance. This profoundly affects their ability to live independently.

Almost 20% of patients never regain the ability to ambulate, and a similar percentage are unable to ambulate outside their homes.

Only 50-65% regain their premorbid ambulatory status.

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Patient Education

Prevention of hip fracture is vastly superior to current treatment modalities. Gear patient education toward identification of avoidable risk factors in the patient's life.

In young persons, stress avoidance of tobacco and alcohol abuse and safe, responsible use of motorized vehicles.

Counsel older persons on ways to make their home environment safe from falls. Encourage them to consult with their primary physician regarding medications or supplements for the prevention and treatment of osteoporosis.

For patient education resources, see the Foot, Ankle, Knee, and Hip Center and Breaks, Fractures, and Dislocations Center.

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