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The Challenges of Anaesthesia and Pain Relief in Hip Fracture Care

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Abstract

The care of the older person with hip fracture is complicated by their comorbid condition, limited physiological reserve, cognitive impairment and frailty. Two aspects of hip fracture management that have received considerable attention are how best to manage the pain associated with it and the ideal mode of anaesthesia. Existing literature has reported on the suboptimal treatment of pain in this orthogeriatric cohort. With recent advancements in medical care, a number of options have emerged as alternatives to conservative systemic analgesia. Systemic analgesia, such as opioids, can lead to untoward side effects, especially in this particular group of patients. Hence, peripheral nerve blocks, epidural analgesia and regional anaesthesia have emerged as options in the delivery of adequate pain relief in hip fractures. Besides that, there is ongoing debate regarding the appropriate anaesthesia technique for surgical repair of the fractured hip. The benefits and risks related to either spinal anaesthesia or general anaesthesia have been subject to studies determining which method is associated with better short- and long-term outcomes. In this review, we aim to examine the evidence behind the different analgesia options available, compare spinal and general anaesthesia, and discuss the importance of the multidisciplinary orthogeriatric model of care in hip fracture and its potential role in other fragility fractures.

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References

  1. National Institute for Clinical Excellence. Hip fracture: management. NICE guidelines [CG124], 2014.

  2. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331:1374.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Baker PN, Salar O, Ollivere BJ, Forward DP, Weerasuriya N, Moppett IK, Moran CG. Evolution of the hip fracture population: time to consider the future? A retrospective observational analysis. BMJ Open. 2014;4:e004405.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthorn PM. Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62:744–51.

    Article  PubMed  Google Scholar 

  6. Seitz DP, Adunuri N, Gill SS, Rochon PA. Prevalence of dementia and cognitive impairment among older adults with hip fractures. J Am Med Dir Assoc. 2011;12:556–64.

    Article  PubMed  Google Scholar 

  7. Wiles MD, Moran CG, Sahota O, Moppett IK. Nottingham Hip Fracture Score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur. Br J Anaesth. 2011;106:501–4.

    Article  CAS  PubMed  Google Scholar 

  8. Devas MB. Geriatric orthopaedics. Br Med J. 1974;1:190–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014;28:e49–55.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med. 2009;169:1712–7.

    Article  PubMed  Google Scholar 

  11. Deschodt M, Braes T, Flamaing J, Detroyer E, Broos P, Haentjens P, Boonen S, Milisen K. Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc. 2012;60:733–9.

    Article  PubMed  Google Scholar 

  12. Scottish Intercollegiate Guidelines Network. Management of hip fracture in older people. Guideline No. 111, 2009.

  13. Australian and New Zealand Hip Fracture Registry (ANZHFR) Steering Group. Australian and New Zealand guideline for hip fracture care: Improving outcomes in hip fracture management of adults. Sydney: Australian and New Zealand Hip Fracture Registry Steering Group; 2014.

  14. Royal College of Physicians, British Geriatrics Society and British Pain Society. The assessment of pain in older people: national guidelines. Concise guidance to good practice series, No 8. London: RCP; 2007.

  15. Feldt KS, Ryden MB, Miles S. Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture. J Am Geriatr Soc. 1998;46:1079–85.

    Article  CAS  PubMed  Google Scholar 

  16. Morrison RS, Siu AL. A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. J Pain Symptom Manag. 2000;19:240–8.

    Article  CAS  Google Scholar 

  17. Jackson SE. The efficacy of an educational intervention on documentation of pain management for the elderly patient with a hip fracture in the Emergency Department. J Emerg Nurse. 2010;36:10–5.

    Article  Google Scholar 

  18. Morrison RS, Magaziner J, Gilbert M, Koval KJ, McLaughlin MA, Orosz G, Strauss E, Siu AL. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol Med Sci. 2003;58A:76–81.

    Article  Google Scholar 

  19. Marcantonio ER, Flacker JM, Michaels M, Resnick NM. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc. 2000;48:618–24.

    Article  CAS  PubMed  Google Scholar 

  20. Sahota O. Femoral nerve block Intervention in Neck of Femur fracture (FINOF): study protocol for a randomized controlled trial. Trials. 2014;15:189.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chau DL, Walker V, Pai L, Cho LM. Opiates and elderly: use and side effects. Clin Interv Aging. 2008;3:273–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. The Association of Anaesthetists of Great Britain and Ireland, Obstetric Anaesthetists’ Association and Regional Anaesthesia UK. Regional anaesthesia and patients with abnormalities of anticoagulation. Anaesthesia. 2013;68:966–72.

    Article  Google Scholar 

  23. Narouze S, Benzon H, Provenzano DA, Buvanendran A, de Andres J, Deer TR, Rauck R, Huntoon MA. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Regional Anesth Pain Med. 2015;40:182–212.

    Article  CAS  Google Scholar 

  24. Nielsen KC, Klein SM, Steele SM. Femoral nerve blocks. Tech Reg Anesth Pain Manag. 2003;7:8–17.

    Article  Google Scholar 

  25. Szucs S, Iohom G, O’Donnell B, Sajgalik P, Ahmad I, Salah N, Shorten G. Analgesic efficacy of continuous femoral nerve block commenced prior to operative fixation of fractured neck of femur. Perioper Med. 2012;1:4.

    Google Scholar 

  26. Haddad FS, Williams RL. Femoral nerve block in extracapsular femoral neck fractures. J Bone Joint Surg Br. 1995;77:922–3.

    CAS  PubMed  Google Scholar 

  27. Del Rosario E, Esteve N, Sernandez MJ, Batet C, Aguilar JL. Does femoral nerve analgesia impact the development of postoperative delirium in the elderly? A retrospective investigation. Acute Pain. 2008;10:59–64.

    Article  Google Scholar 

  28. Fletcher AK, Rigby AS, Heyes FLP. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the Emergency Department: a randomized, controlled trial. Ann Emerg Med. 2003;41:227–33.

    Article  PubMed  Google Scholar 

  29. Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in Emergency Department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013;20:584–91.

    Article  PubMed  Google Scholar 

  30. Luger TJ, Kammerlander C, Benz M, Luger MF, Garoscio I. Peridural anesthesia or ultrasound-guided continuous 3-in-1 block: which is indicated for analgesia in very elderly patients with hip fracture in the Emergency Department? Geriatr Orthop Surg Rehabil. 2012;3:121–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Tuncer S, Okkuyun Sert O, Yosunkaya A, Mutlu M, Celik J, Okesli S. Patient-controlled femoral nerve analgesia versus patient-controlled intravenous analgesia for postoperative analgesia after trochanteric fracture repair. Acute Pain. 2013;4:105–8.

    Article  Google Scholar 

  32. Hood G, Edbrooke DL, Gerrish SP. Postoperative analgesia after triple nerve block for fractured femur. Anaesthesia. 1991;46:138–40.

    Article  CAS  PubMed  Google Scholar 

  33. Coad NR. Post-operative analgesia following femoral-neck surgery—a comparison between 3 in 1 femoral nerve block and lateral cutaneous nerve block. Eur J Anaesthesiol. 1991;8:287–90.

    CAS  PubMed  Google Scholar 

  34. Foss NB, Kristensen BB, Bundgaard M, Bak M, Heiring C, Virkelyst C, Hougaard S, Kehlet H. Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial. Anaesthesiology. 2007;106:773–8.

    Article  CAS  Google Scholar 

  35. Diakomi M, Papaioannou M, Mela A, Kouskouni E, Makris A. Preoperative fascia iliaca compartment block for positioning patients with hip fractures for central nervous blockade: a randomized trial. Reg Anaesth Pain Med. 2014;39:394–8.

    Article  CAS  Google Scholar 

  36. Fujihara Y, Fukunishi S, Nishio S, Miura J, Koyanagi S, Yoshiya S. Fascia iliaca compartment block: its efficacy in pain control for patients with proximal femoral fracture. J Orthop Sci. 2013;28:793–7.

    Article  Google Scholar 

  37. Nie H, Yang Y, Wang Y, Liu Y, Zhao B, Luan B. Effects of continuous fascia iliaca compartment blocks for postoperative analgesia in patients with hip fracture. Pain Res Manag. 2015;20:210–2.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Mangram AJ, Oguntodu OF, Hollingworth AK, Prokuski L, Steinstra A, Collins M, Sucher JF, Ali-Osman F, Dzandu JK. Geriatric trauma G-60 falls with hip fractures: a pilot study of acute pain management using femoral nerve fascia iliac blocks. J Trauma Acute Care Surg. 2015;79:1067–72.

    Article  PubMed  Google Scholar 

  39. Yun MJ, Kim YH, Han MK, Kim JH, Hwang JW, Do SH. Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block. Acta Anaesthesiol Scand. 2009;53:1282–7.

    Article  CAS  PubMed  Google Scholar 

  40. Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized, placebo-controlled study. J Orthopaed Traumatol. 2009;10:127–33.

    Article  Google Scholar 

  41. Chudinov A, Berkenstadt H, Salai M, Cahana A, Perel A. Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures. Reg Anaesth Pain Med. 1999;24:563–8.

    Article  CAS  Google Scholar 

  42. Turker G, Uckunkaya N, Yavascaoglu B, Yilmazlar A, Ozcelik S. Comparison of the catheter-technique psoas compartment block and the epidural block for analgesia in partial hip replacement surgery. Acta Anaesthesiol Scand. 2003;47:30–6.

    Article  CAS  PubMed  Google Scholar 

  43. Jones SF, White A. Analgesia following femoral neck surgery: lateral cutaneous nerve block as an alternative to narcotics in the elderly. Anaesthesia. 1985;40:682–5.

    Article  CAS  PubMed  Google Scholar 

  44. Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, Benger J. Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department. Emerg Med J. 2015;32:685–9.

    Article  PubMed  Google Scholar 

  45. Newman B, McCarthy L, Thomas PW, May P, Layzell M, Horn K. A comparison of pre-operative nerve stimulator-guided femoral nerve block and fascia iliaca compartment block in patients with a femoral neck fracture. Anaesthesia. 2013;68:899–903.

    Article  CAS  PubMed  Google Scholar 

  46. Scheinin H, Virtanen T, Kentala E, Uotila P, Laitio T, Hartiala J, Heikkila H, Sriola-Heinonen K, Pullisaar O, Yli-Mayry S, Jalonen J. Epidural infusion of bupivacaine and fentanyl reduces perioperative myocardial ischaemia in elderly patients with hip fracture—a randomized controlled trial. Acta Anaesthesiol Scand. 2000;44:1061–70.

    Article  CAS  PubMed  Google Scholar 

  47. Foss NB, Kristensen MT, Kristensen BB, Jensen PS, Kehlet H. Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery. Anesthesiology. 2005;102:1197–204.

    Article  CAS  PubMed  Google Scholar 

  48. Rashwan D. Levobupivacaine patient controlled analgesia: epidural versus blind fascia iliaca compartment analgesia—a comparative study. Egypt J Anaesth. 2013;29:155–9.

    Article  Google Scholar 

  49. Kwan ASK, Lee BB, Brake T. Intrathecal morphine for post-operative analgesia in patients with fractured hips. HKMJ. 1997;3:250–5.

    PubMed  Google Scholar 

  50. Malek J, Kurzova A. Intrathecal fentanyl and sufentanil added to bupivacaine augments analgesia after surgical repair of hip fracture. Acute Pain. 2004;6:53–6.

    Article  CAS  Google Scholar 

  51. Bech RD, Lauritsen J, Ovesen O, Emmeluth C, Lindholm P, Overgaard S. Local anaesthetic wound infiltration after internal fixation of femoral neck fractures: a randomized, double-blind clinical trial in 33 patients. Hip Int. 2011;22:251–9.

    Article  Google Scholar 

  52. Kang H, Ha Y, Kim J, Woo Y, Lee J, Jang E. Effectiveness of multimodal pain management after bipolar hemiarthroplasty for hip fracture. J Bone Joint Surg Am. 2013;95:291–6.

    Article  PubMed  Google Scholar 

  53. Bollinger AJ, Butler PD, Niew MS, Sietsema DL, Jones CB, Endres TJ. Is scheduled intravenous acetaminophen effective in the pain management protocol of geriatric hip fractures? Geriatr Orthop Surg Rehabil. 2015;6:202–8.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Tsang KS, Page J, Mackenney P. Can intravenous paracetamol reduce opioid use in preoperative hip fracture patients? Orthopedics. 2013;36:20–4.

    Article  PubMed  Google Scholar 

  55. Fredman B, Zohar E, Tarabykin A, Shapiro A, Jedeikin R. Continuous intravenous diclofenac does not induce opioid-sparing or improve analgesia in geriatric patients undergoing major orthopaedic surgery. J Clin Anesth. 2000;12:531–6.

    Article  CAS  PubMed  Google Scholar 

  56. Dodwell ER, Latorre JG, Parisini E, Zwettler E, Chandra D, Mulpuri K, Snyder B. NSAID exposure and risk of nonunion: a meta-analysis of case–control and cohort studies. Calcif Tissue Int. 2010;87:193–202.

    Article  CAS  PubMed  Google Scholar 

  57. Matot I, Oppenheim-Eden A, Ratrot R, Baranova J, Davidson E, Eylon S, Peyser A, Liebergall M. Preoperative cardiac events in elderly patients with hip fracture randomized to epidural or conventional analgesia. Anesthesiology. 2003;98:156–63.

    Article  PubMed  Google Scholar 

  58. Rizk P, Morris W, Oladeji P, Huo M. Review of postoperative delirium in geriatric patients undergoing hip surgery. Geriatr Orthop Surg Rehabil. 2016;7:100–5.

    Article  PubMed  Google Scholar 

  59. Clegg A, Young J. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing. 2011;40:23–9.

    Article  PubMed  Google Scholar 

  60. Adunsky A, Levy R, Hein M, Mizrahi E, Arad M. Meperidine analgesia and delirium in aged hip fracture patients. Arch Gerontol Geriatr. 2002;35:253–9.

    Article  CAS  PubMed  Google Scholar 

  61. White SM, Moppett IK, Griffiths R. Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65535 patients in a national dataset. Anaesthesia. 2014;69:224–30.

    Article  CAS  PubMed  Google Scholar 

  62. Maxwell L, White S. Anaesthetic management of patients with hip fractures: an update. Contin Educ Anaesth Crit Care Pain. 2013;13:179–83.

    Article  Google Scholar 

  63. Royal College of Physicians. National Hip Fracture Database annual report 2015. London: RCP; 2015.

  64. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M. Effect of early surgery after hip fracture on mortality ad complications: systematic review and meta-analysis. CMAJ. 2010;182:1609–16.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Shih Y, Hsieh C, Kang T, Peng S, Fan K, Wang L. General versus spinal anesthesia: which is a risk factor for octogenarian hip fracture repair patients? Int J Gerontol. 2010;4:37–42.

    Article  Google Scholar 

  66. Casati A, Aldegheri G, Vinciguerra F, Marsan A, Fraschini G, Torri G. Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery. Eur J Anaesthesiol. 2003;20:640–6.

    Article  CAS  PubMed  Google Scholar 

  67. Guay J, Parker MJ, Gajendragadkar PR, Kopp S. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2016;(2):CD000521. doi:10.1002/14651858.CD000521.pub3.

  68. Hirsch J, DePalma G, Tsai TT, Sands LP, Leung JM. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth. 2015;115:418–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123:515–23.

    Article  PubMed  Google Scholar 

  70. Biboulet P, Jourdan A, Van Haevre V, Morau D, Bernard N, Bringuier S, Capdevila X. Hemodynamic profile of target-controlled spinal anesthesia compared with 2 target-controlled general anesthesia techniques in elderly patients with cardiac comorbidities. Reg Anesth Pain Med. 2012;37:433–40.

    Article  CAS  PubMed  Google Scholar 

  71. Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine–fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anesthesiology. 2000;92:6–10.

    Article  CAS  PubMed  Google Scholar 

  72. Maurette P, Bonada G, Djiane V, Erny P. A comparison between lidocaine alone and lidocaine with meperidine for continuous spinal anesthesia. Reg Anesth. 1993;18:290–5.

    CAS  PubMed  Google Scholar 

  73. Juelsgaard P, Sand NPR, Felsby S, Dalsgaard J, Jakobsen KB, Brink O, Carlsson PS, Thygesen K. Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia. Eur J Anaesthesiol. 1998;15:656–63.

    Article  CAS  PubMed  Google Scholar 

  74. Ture H, Usluer A, Eti Z, Varlik DI, Gogus FY. The effect of anaesthetic technique on postoperative venous thromboembolism in elderly patients undergoing total hip replacement. Marmara Med J. 2008;21:146–51.

    Google Scholar 

  75. Valentin N, Lomholt B, Jensen JS, Hejgaard N, Kreiner S. Spinal or general anaesthesia for surgery of the fractured hip? Br J Anaesth. 1986;58:284–91.

    Article  CAS  PubMed  Google Scholar 

  76. Whiting PS, Molina CS, Greenberg SE, Thakore RV, Obremskey WT, Sethi MK. Regional anaesthesia for hip fracture surgery is associated with significantly more peri-operative complications compared with general anaesthesia. Int Orthop. 2015;39:1321–7.

    Article  PubMed  Google Scholar 

  77. Sutcliffe AJ, Parker M. Mortality after spinal and general anaesthesia for surgical fixation of hip fractures. Anaesthesia. 1994;49:237–40.

    Article  CAS  PubMed  Google Scholar 

  78. Koval KJ, Aharonoff GB, Rosenberg AD, Schmigelski C, Bernstein RL, Zuckerman JD. Hip fracture in the elderly: the effect of anesthetic technique. Orthopedics. 1999;22:31–4.

    CAS  PubMed  Google Scholar 

  79. Luger TJ, Kammerlander C, Gosch M, Luger MF, Kammerlander-Knauer U, Roth T, Kreutziger J. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporos Int. 2010;21:555–72.

    Article  CAS  Google Scholar 

  80. Sieber FE, Zakriya KJ, Gottschalk A, Blute M-R, Lee HB, Rosenberg PB, Mears SC. Sedation depth during spinal anaesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc. 2010;85:18–26.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Berggren D, Gustafson Y, Eriksson B, Bucht G, Hansson L, Reiz S, Winblad B. Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesth Analg. 1987;66:497–504.

    Article  CAS  PubMed  Google Scholar 

  82. Davis FM, Woolner DF, Frampton C, Wilkinson A, Grant A, Harrison RT, Roberts MTS, Thadaka R. Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth. 1987;59:1080–8.

    Article  CAS  PubMed  Google Scholar 

  83. White IWC, Chappell WA. Anaesthesia for surgical correction of fractured femoral neck: a comparison of three techniques. Anaesthesia. 1980;35:1107–10.

    Article  CAS  PubMed  Google Scholar 

  84. Le-Wendling L, Bihorac A, Ozrazgat Baslanti T, Lucs S, Sadasivan K, Wendling A, Heyman HJ, Boezaart A. Regional anesthesia as compared with general anesthesia for surgery in geriatric patients with hip fracture: does it decrease morbidity, mortality and health care costs? Results of a single-centered study. Pain Med. 2012;13:948–56.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Walters S, Chan S, Goh L, Ong T, Sahota O. The prevalence of frailty in patients admitted to hospital with vertebral fragility fractures. Curr Rheumatol Rev. 2016;12:244–7.

    Article  PubMed  Google Scholar 

  86. Tamayo-Orozco J, Arzac-Palumbo P, Peon-Vidales H, Mota-Bolfeta R, Fuentes F. Vertebral fractures associated with osteoporosis: patient management. Am J Med. 1997;103:44S–8S.

    Article  CAS  PubMed  Google Scholar 

  87. Aw D, Sahota O. Orthogeriatrics moving forward. Age Ageing. 2014;43:301–5.

    Article  PubMed  Google Scholar 

  88. Ensrud KE, Thompson DE, Cauley JA, Nevitt MC, Kado DM, Hochberg MC, Santora AC 2nd, Black DM. Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group. J Am Geriatr Soc. 2000;48:241–9.

    Article  CAS  PubMed  Google Scholar 

  89. National Institute for Clinical Excellence. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures. NICE technology appraisal guidance [TA279], 2013.

  90. Buchbinder R, Osborne RH, Ebeling PR, Ward JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361:557–68.

    Article  CAS  PubMed  Google Scholar 

  91. Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361:569–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Clark W, Bird P, Gonski P, Diamond TH, Smerdely P, McNeil P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic vertebral fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016;388:1408–16.

    Article  PubMed  Google Scholar 

  93. Peichl P, Holzer LA, Maier R, Holzer G. Parathyroid hormone 1–84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. J Bone Joint Surg Am. 2011;93:1583–7.

    Article  PubMed  Google Scholar 

  94. Bayley E, Srinivas S, Boszczyk BM. Clinical outcomes of sacroplasty in sacral insufficiency fractures: a review of the literature. Eur Spine J. 2009;18:1266–71.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Department for Healthcare of Older People, Queens Medical Centre, HCOP Research Office, Nottingham University Hospitals NHS Trust, F Floor, West Block, Derby Road, Nottingham, NG7 2UH, UK

    Rachel Cowan, Jun Hao Lim, Terence Ong & Opinder Sahota

  2. School of Medicine, University of Nottingham, Medical School, Nottingham, UK

    Terence Ong & Ashok Kumar

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  1. Rachel Cowan
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Correspondence to Terence Ong.

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RC, JL, TO, AK and OS declare no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

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TO is a current recipient of a research training fellowship by The Dunhill Medical Trust [Grant Number: RTF49/0114].

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Cowan, R., Lim, J.H., Ong, T. et al. The Challenges of Anaesthesia and Pain Relief in Hip Fracture Care. Drugs Aging 34, 1–11 (2017). https://doi.org/10.1007/s40266-016-0427-5

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