Loading your page…
Loading your page…
Published by American Academy of Orthopaedic Surgeons · GRADE Evidence-to-Decision Framework
This guideline offers evidence-based recommendations for the surgical and perioperative management of hip fractures in older adults. It focuses on aspects such as optimal surgical timing, venous thromboembolism prophylaxis, multimodal analgesia, surgical approaches, and the efficacy of interdisciplinary care programs in improving patient outcomes.
Key Takeaways
This CPG replaces the 1st edition (2014). Key changes include the adoption of the GRADE Evidence-to-Decision Framework, assigning all observational studies a base appraisal of low-quality evidence, updating study appraisal methodology (coinciding with Cochrane, ROBINs, QUADAS, QUIPs), and mandating a sample size of >= 30 per comparison group with an average participant age of at least 65 years.
Preoperative traction should not routinely be used for patients with a hip fracture.
Hip fracture surgery within 24-48 hours of admission may be associated with better outcomes.
Venous thromboembolism (VTE) prophylaxis should be used in hip fracture patients.
Either spinal or general anesthesia is appropriate for patients with a hip fracture.
In patients with unstable (displaced) femoral neck fractures, arthroplasty is recommended over fixation.
In patients with unstable (displaced) femoral neck fractures, unipolar or bipolar hemiarthroplasty can be equally beneficial.
In properly selected patients with unstable (displaced) femoral neck fractures, there may be a functional benefit to total hip arthroplasty over hemi arthroplasty at the risk of increasing complications.
In patients undergoing arthroplasty for femoral neck fractures, the use of cemented femoral stems is recommended.
In patients undergoing treatment of femoral neck fractures with hip arthroplasty, evidence does not show a favored surgical approach.
In patients with stable intertrochanteric fractures, use of either a sliding hip screw or a cephalomedullary device is recommended.
In patients with subtrochanteric or reverse obliquity fractures a cephalomedullary device is recommended.
Patients with unstable intertrochanteric fractures should be treated with a cephalomedullary device.
A blood transfusion threshold of no higher than 8g/dl is suggested in asymptomatic postoperative hip fracture patients.
Multimodal analgesia incorporating preoperative nerve block is recommended to treat pain after hip fracture.
Tranexamic acid should be administered to reduce blood loss and blood transfusion in patients with hip fractures.
Interdisciplinary care programs should be used in the care of hip fracture patients to decrease complications and improve outcomes.
In patients with stable (impacted/non-displaced) femoral neck fractures, hemiarthroplasty, internal fixation or non-operative care may be considered.
In patients with pertrochanteric femur fractures, short or long cephalomedullary nail may be considered.
Following surgical treatment of hip fractures, immediate, full weight bearing to tolerance may be considered.
Clinical Topic
Hip Fractures
Objectives
To evaluate the current best evidence associated with the surgical treatment of hip fractures in older adults and provide recommendations to guide clinical practice.
Target Patient Population
Adults aged 65 years and older (with a lower limit of 55 years) diagnosed with a hip fracture.
Target Providers
Therapeutic Area
Musculoskeletal CareGuideline Scope
Inclusion Criteria
Exclusion Criteria
Care Settings
Special Populations
System: GRADE Evidence-to-Decision Framework
Evidence Distribution
Evidence Levels
Recommendation Strength
Contraindications
Monitoring Guidance
A blood transfusion threshold of no higher than 8g/dl is suggested in asymptomatic postoperative hip fracture patients.
Difficulty
advanced
Exam Relevance
Learning Paths