treatment

Last reviewed 01/2018

Timing of surgery

  • perform surgery on the day of, or the day after, admission

  • identify and treat correctable comorbidities immediately so that surgery is not delayed by:
    • anaemia
    • anticoagulation
    • volume depletion
    • electrolyte imbalance
    • uncontrolled diabetes
    • uncontrolled heart failure
    • correctable cardiac arrhythmia or ischaemia
    • acute chest infection
    • exacerbation of chronic chest conditions

Surgical procedures

  • offer replacement arthroplasty (total hip replacement or hemiarthroplasty) to patients with a displaced intracapsular hip fracture

  • offer total hip replacements to patients with a displaced intracapsular fracture who:
    • were able to walk independently out of doors with no more than the use of a stick and are
    • not cognitively impaired
    • and are medically fit for anaesthesia and the procedure

  • use a proven femoral stem design rather than Austin Moore or Thompson stems for arthroplasties

  • use cemented implants in patients undergoing surgery with arthroplasty

  • consider an anterolateral approach in favour of a posterior approach when inserting a hemiarthroplasty

  • use extramedullary implants such as a sliding hip screw in preference to an intramedullary nail in patients with trochanteric fractures above and including the lesser trochanter (AO classification types A1 and A2)

  • use an intramedullary nail to treat patients with a subtrochanteric fracture

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