Operative Management of Geriatric Hip Fractures: An Evidence-Based Note Template
DOI:
https://doi.org/10.55576/job.v3i1.26Keywords:
Hip Fracture, Operative Management, Surgical technique, Geriatrics, Fragility fracture, Osteoporosis, Femoral neck fracture, Intertrochanteric hip fracture, Subtrochanteric hip fracture, Hemi Hip Arthroplasty, Total Hip Arthroplasty, Sliding hip screw, cannulated screw fixation, Cephalomedullary nail, Intramedullary nailAbstract
Objectives: Provide a framework for the surgical treatment of patients with proximal femur fractures.
Design: Literature review.
Main outcome measurement: Review of evidence-based surgical techniques for specific hip fracture patterns.
Results: Proximal femur fractures are common orthopaedic injuries in the geriatric population, and are subcategorized into femoral neck, intertrochanteric and subtrochanteric hip fractures. Non-operative management is reserved only for those patients where the risk of anesthesia outweighs the benefit of operative intervention. Femoral neck fractures are treated with either internal fixation or arthroplasty. Internal fixation remains a viable form of fixation in particular patient subgroups and is often driven by fracture pattern. Controversy continues regarding Total Hip Arthroplasty (THA) versus Hemi Hip Arthroplasty (HA). The main factor in the decision to proceed with THA is the pre-injury functional level of the patient, though no clear consensus has been reached as to precise definitions of functionality or thresholds for chronologic age. Choice of implant for treatment of intertrochanteric hip fractures is determined by fracture stability. Stable fracture patterns may be treated by either a sliding hip screw (SHS) or cephalomedullary nail (CMN), with no current difference in total associated cost. Intramedullary nails remain the gold-standard and mainstay of treatment of subtrochanteric hip fractures.
Conclusions: A thorough understanding of the differences in operative management of geriatric hip fractures may help orthopedic surgeons optimize patient outcomes as well as minimize health care costs related to implant choice.
Level of Evidence: IV, systematic review
Keywords: Hip Fracture, Operative Management, Surgical technique, Medical co-management, Geriatrics, Fragility fracture, Osteoporosis, Femoral neck fracture, Intertrochanteric hip fracture, Subtrochanteric hip fracture, Hemi Hip Arthroplasty, Total Hip Arthroplasty, Sliding hip screw, cannulated screw fixation, Cephalomedullary nail, Intramedullary nail
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