Hip Fracture in the ED Guidelines

Updated: Aug 12, 2021
  • Author: Moira Davenport, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Guidelines

Guidelines Summary

The American Academy of Orthopaedic Surgeons published guidelines on the management of hip fractures in patients older than 65 years. Recommendations supported by strong evidence include the following [40, 41] :

  • Regional analgesia can be used to improve preoperative pain control in patients with hip fracture.
  • In patients undergoing hip fracture surgery, similar outcomes can be achieved with general or spinal anesthesia.
  • Arthroplasty should be used for patients with unstable (displaced) femoral neck fractures.
  • Use of a cephalomedullary device is recommended for the treatment of patients with subtrochanteric or reverse obliquity fractures.
  • In asymptomatic postoperative hip fracture patients, a blood transfusion threshold of no higher than 8 g/dl should be used.
  • Intensive postdischarge physical therapy improves functional outcomes.
  • Use of an interdisciplinary care program in hip fracture patients with mild to moderate dementia improves functional outcomes.
  • Multimodal pain management should be used after hip fracture surgery.

According to the American College of Radiology (ACR) Appropriateness Criteria, radiography should always be the initial imaging modality. Then, depending on the clinical concern, additional studies can be obtained. MRI is recommended if the presence of a fracture is equivocal on radiographs. CT is the recommended alternative if MRI is contraindicated. [5]