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Medical Management

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Proximal Femur Fractures

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Abstract

Hip fractures are a common occurrence, especially in the elderly population, and usually occur after a fall. Consequences of hip fractures are significant and have an impact on overall mortality, quality of life, and cognitive function. Patients who experience hip fractures are usually intermediate- to high-risk surgical candidates, and care should be taken to optimize their underlying medical conditions in the perioperative period. This should, however, not lead to inordinate delay in surgical repair, since outcomes are worse when surgery is delayed. Complications are common after hip fracture surgery and include venous thromboembolism, infections, pressure sores, and delirium. Patients should be carefully observed in the perioperative period, and a high index of suspicion for these complications should be maintained since the elderly might not exhibit the classical signs of such disease processes. Early rehabilitation and nutritional support are instrumental in attaining good functional recovery and preventing recurrent fractures.

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References

  1. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302(14):1573–9. https://doi.org/10.1001/jama.2009.1462.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Roberts SE, Goldacre MJ. Time trends and demography of mortality after fractured neck of femur in an English population, 1968–98: database study. BMJ. 2003;327(7418):771–5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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. https://doi.org/10.1111/j.1532-5415.1998.tb06644.x.

    Article  CAS  PubMed  Google Scholar 

  4. Colón-Emeric CS. Postoperative management of hip fractures: interventions associated with improved outcomes. Bonekey Rep. 2012;1:241. https://doi.org/10.1038/bonekey.2012.241.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Parker MJ, Griffiths R, Appadu BN. Nerve blocks (subcostal, lateral cutaneous,femoral, triple, psoas) for hip fractures. Cochrane Database Syst Rev 2002;1:CD001159.

    Google Scholar 

  6. Christos SC, Chiampas G, Offman R, Rifenburg R. Ultrasound-guided three-in-one nerve block for femur fractures. West J Emerg Med. 2010;11(4):310–3.

    PubMed  PubMed Central  Google Scholar 

  7. Association of Anaesthetists of Great Britain and Ireland, Griffiths R, Alper J, Beckingsale A, Goldhill D, Heyburn G, Holloway J, Leaper E, Parker M, Ridgway S, White S, Wiese M, Wilson I. Management of proximal femoral fractures 2011: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2012;67(1):85–98. https://doi.org/10.1111/j.1365-2044.2011.06957.x.

    Article  Google Scholar 

  8. Pedersen SJ, Borgbjerg FM, Schousboe B, Pedersen BD, Jørgensen HL, Duus BR, Lauritzen JB, Hip Fracture Group of Bispebjerg Hospital. A comprehensive hip fracture program reduces complication rates and mortality. J Am Geriatr Soc. 2008;56(10):1831–8. https://doi.org/10.1111/j.1532-5415.2008.01945.x.

    Article  PubMed  Google Scholar 

  9. Rao SS, Cherukuri M. Management of hip fracture: the family physician’s role. Am Fam Physician. 2006;73(12):2195–200.

    PubMed  Google Scholar 

  10. Bateman L, Vuppala S, Porada P, et al. Medical management in the acute hip fracture patient: a comprehensive review for the internist. Ochsner J. 2012;12(2):101–10.

    PubMed  PubMed Central  Google Scholar 

  11. McLaughlin MA, Orosz GM, Magaziner J, et al. Preoperative status and risk of complications in patients with hip fracture. J Gen Intern Med. 2006;21(3):219–25. https://doi.org/10.1111/j.1525-1497.2006.00318.x.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Michel JP, Klopfenstein C, Hoffmeyer P, et al. Hip fracture surgery: is the pre-operative American Society of Anesthesiologists (ASA) score a predictor of functional outcome? Aging Clin Exp Res. 2002;14:389–94.

    Article  PubMed  Google Scholar 

  13. Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, Garcia DA, Jacobson A, Jaffer AK, Kong DF, Schulman S, Turpie AG, Hasselblad V, Ortel TL, Investigators BRIDGE. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373(9):823–33. https://doi.org/10.1056/NEJMoa1501035.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. 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(7529):1374. https://doi.org/10.1136/bmj.38643.663843.55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Dovjak P, Iglseder B, Mikosch P, Gosch M, Müller E, Pinter G, Pils K, Gerstofer I, Thaler H, Zmaritz M, Weissenberger-Leduc M, Müller W. Treatment and prevention of postoperative complications in hip fracture patients: infections and delirium. Wien Med Wochenschr. 2013;163(19-20):448–54. https://doi.org/10.1007/s10354-013-0228-y.

    Article  PubMed  Google Scholar 

  16. Busse PJ, Mathur SK. Age-related changes in immune function: effect on airway inflammation. J Allergy Clin Immunol. 2010;126(4):690–699.; quiz 700-1. https://doi.org/10.1016/j.jaci.2010.08.011.

  17. Grant PJ, Jaffer AK. When should prophylactic anticoagulation begin after a hip fracture? Cleve Clin J Med. 2006;73(9):785–6. 788, 790 Review

    Article  PubMed  Google Scholar 

  18. Todd CJ, Freeman CJ, Camilleri-Ferrante C, et al. Differences in mortality after fracture of hip: the east Anglian audit. BMJ. 1995;310:904–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Fisher CG, Blachut PA, Salvian AJ, Meek RN, O'Brien PJ. Effectiveness of pneumatic leg compression devices for the prevention of thromboembolic disease in orthopaedic trauma patients: a prospective, randomized study of compression alone versus no prophylaxis. J Orthop Trauma. 1995;9:1–7.

    Article  CAS  PubMed  Google Scholar 

  20. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ, American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):7S–47S. https://doi.org/10.1378/chest.1412S3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Young MD, Daniels AH, Evangelista PT, Reinert SE, Ritterman S, Christino MA, Thakur NA, Born CT. Predicting pulmonary embolus in orthopedic trauma patients using the Wells score. Orthopedics. 2013;36(5):e642–7. https://doi.org/10.3928/01477447-20130426-29.

    Article  PubMed  Google Scholar 

  22. Gustafson Y, Berggren D, Brannstrom B, Bucht G, Norberg A, Hansson LI, Win-blad B. Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc. 1988;36:525–30.

    Article  CAS  PubMed  Google Scholar 

  23. Robertson BD, Robertson TJ. Postoperative delirium after hip fracture. J Bone Joint Surg Am. 2006;88(9):2060–8. Review

    PubMed  Google Scholar 

  24. Haleem S, Heinert G, Parker MJ. Pressure sores and hip fractures. Injury. 2008;39(2):219–23. https://doi.org/10.1016/j.injury.2007.08.030.

    Article  CAS  PubMed  Google Scholar 

  25. Baumgarten M, Rich SE, Shardell MD, Hawkes WG, Margolis DJ, Langenberg P, Orwig DL, Palmer MH, Jones PS, Sterling R, Kinosian BP, Magaziner J. Care-related risk factors for hospital-acquired pressure ulcers in elderly adults with hip fracture. J Am Geriatr Soc. 2012;60(2):277–83. https://doi.org/10.1111/j.1532-5415.2011.03849.x.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Thomas DR. Prevention and treatment of pressure ulcers. J Am Med Dir Assoc. 2006;7(1):46–59. Review

    Article  PubMed  Google Scholar 

  27. Berlowitz DR, Wilking SV. The short-term outcome of pressure sores. J Am Geriatr Soc. 1990;38(7):748–52.

    Article  CAS  PubMed  Google Scholar 

  28. Gruson KI, Aharonoff GB, Egol KA, Zuckerman JD, Koval KJ. The relationship between admission hemoglobin level and outcome after hip fracture. J Orthop Trauma. 2002;16(1):39–44.

    Article  PubMed  Google Scholar 

  29. Halm EA, Wang JJ, Boockvar K, et al. The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture. J Orthop Trauma. 2004;18(6):369–74.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Carson JL, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365(26):2453–62. https://doi.org/10.1056/NEJMoa1012452.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Siu AL, Penrod JD, Boockvar KS, Koval K, Strauss E, Morrison RS. Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med. 2006;166(7):766–71.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ, Bailey MJ. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg. 2006;76:607–11. https://doi.org/10.1111/j.1445-2197.2006.03786.x.

    Article  PubMed  Google Scholar 

  33. Bell J, Bauer J, Capra S, Pulle CR. Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine? Can J Physiol Pharmacol. 2013 Jun;91(6):489–95. https://doi.org/10.1139/cjpp-2012-0301.

    Article  CAS  PubMed  Google Scholar 

  34. Bonjour JP, Schurch MA, Rizzoli R. Nutritional aspects of hip fractures. Bone. 1996;18(3 Suppl):139S–44S. Review

    Article  CAS  PubMed  Google Scholar 

  35. Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Grosman B, Frishman S, Salai M, Beloosesky Y. The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity and outcome. Clin Nutr. 2012;31(6):917–21.

    Article  PubMed  Google Scholar 

  36. Meunier P. Prevention of hip fractures by correcting calcium and vitamin D insufficiencies in elderly people. Scand J Rheumatol. 1996;103:75–8. discussion 79-80

    Article  CAS  Google Scholar 

  37. Shen SH, Huang KC, Tsai YH, Yang TY, Lee MS, Ueng SW, Hsu RW. Risk analysis for second hip fracture in patients after hip fracture surgery: a nationwide population-based study. J Am Med Dir Assoc. 2014;15(10):725–31. https://doi.org/10.1016/j.jamda.2014.05.010.

    Article  PubMed  Google Scholar 

  38. Mak JC, Cameron ID, March LM, National Health and Medical Research Council. Evidence-based guidelines for the management of hip fractures in older persons:an update. Med J Aust. 2010;192(1):37–41. Review

    PubMed  Google Scholar 

  39. Harwood RH, Sahota O, Gaynor K, et al. A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: the Nottingham Neck of Femur (NONOF) study. Age Ageing. 2004;33:45–51.

    Article  PubMed  Google Scholar 

  40. Wells GA, Cranney A, Peterson J, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2008;1:CD001155.

    Google Scholar 

  41. Lyles KW, Colon-Emeric CS, Magaziner JS, et al. HORIZON recurrent fracture trial. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357:1799–809.

    Article  CAS  PubMed  Google Scholar 

  42. Birks YF, Hildreth R, Campbell P, et al. Randomised controlled trial of hip protectors for the prevention of second hip fractures. Age Ageing. 2003;32:442–24.

    Article  PubMed  Google Scholar 

  43. Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990;45:101–M107.

    Article  Google Scholar 

  44. Gruber-Baldini AL, Zimmerman S, Morrison RS, Grattan LM, Hebel JR, Dolan MM, Hawkes W, Magaziner J. Cognitive impairment in hip fracture patients: timing of detection and longitudinal follow-up. J Am Geriatr Soc. 2003;51(9):1227–36.

    Google Scholar 

  45. Dy CJ, Dossous P-M, Ton QV, Hollenberg JP, Lorich DG, Lane JM. Does a multidisciplinary team decrease complications in male patients with hip fractures? Clin Orthop Relat Res. 2011;469(7):1919–24. https://doi.org/10.1007/s11999-011-1825-y.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Bellevue Hospital Center, 462 First Avenue NBV-10W15, New York, NY, 10016, USA

    Vikramjit Mukherjee

  2. Division of Pulmonary, Critical Care and Sleep Medicine, NYU Langone Orthopedic Hospital, 301 E 17th St #550, New York, NY, 10003, USA

    Ezra Dweck

Authors
  1. Vikramjit Mukherjee
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  2. Ezra Dweck
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Correspondence to Ezra Dweck .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, USA

    Kenneth A. Egol

  2. Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, USA

    Philipp Leucht

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Mukherjee, V., Dweck, E. (2018). Medical Management. In: Egol, K., Leucht, P. (eds) Proximal Femur Fractures. Springer, Cham. https://doi.org/10.1007/978-3-319-64904-7_12

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  • DOI: https://doi.org/10.1007/978-3-319-64904-7_12

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-64904-7

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