What is the procedure to fix a broken hip?

Surgical Treatment of Hip Fractures

The surgical procedure for fixing a broken hip depends on the fracture type, with arthroplasty recommended for unstable femoral neck fractures and either sliding hip screws or cephalomedullary devices for intertrochanteric fractures. 1

Types of Hip Fractures and Recommended Procedures

Hip fractures are categorized by anatomical location, which determines the appropriate surgical intervention:

Femoral Neck Fractures

• Unstable (displaced) fractures:

  • Arthroplasty is strongly recommended over internal fixation 1
  • Options include:
    • Hemiarthroplasty (unipolar or bipolar - both equally beneficial) 1
    • Total hip arthroplasty (THA) - may provide functional benefits in properly selected patients but with potentially increased complications 1
  • Cemented femoral stems should be used during arthroplasty (strong recommendation) 1

• Stable (nondisplaced) fractures:

  • Options include hemiarthroplasty, internal fixation, or nonsurgical care 1

Intertrochanteric Fractures

• Stable intertrochanteric fractures:

  • Either sliding hip screw or cephalomedullary device is recommended 1

• Subtrochanteric or reverse obliquity fractures:

  • Cephalomedullary device is strongly recommended 1

Timing of Surgery

• Surgery should be performed within 24-48 hours of hospital admission for better outcomes (moderate recommendation) 1
• Delayed surgical treatment beyond 48 hours is associated with significantly higher mortality 2

Anesthesia Considerations

• Either spinal or general anesthesia is appropriate (strong recommendation) 1
• Regional anesthesia may reduce the incidence of postoperative confusion 1
• For spinal anesthesia:
  • Lower doses of intrathecal bupivacaine (<10 mg) can reduce associated hypotension 1
  • Intrathecal fentanyl is preferred over morphine or diamorphine for prolonged analgesia 1
• For general anesthesia:
  • Reduced doses of intravenous induction agents should be administered 1
  • Higher inspired oxygen concentrations may be required 1

Perioperative Management

• Preoperative traction should NOT be used (strong recommendation) 1

• Pain management:

  • Multimodal analgesia incorporating preoperative nerve block is strongly recommended 1
  • Peripheral nerve blockade (femoral nerve/fascia iliaca block) reduces postoperative analgesic requirements 1
  • Avoid opioid analgesics as the sole adjunct due to risk of respiratory depression and confusion 1

• Tranexamic acid should be administered to reduce blood loss and blood transfusion (strong recommendation) 1

• Thromboembolic prophylaxis:

  • Low-molecular-weight heparin is preferred 3

Postoperative Care

• Interdisciplinary care programs should be used to decrease complications and improve outcomes 1
• Early mobilization is essential - almost all patients should be allowed to mobilize without restrictions on weight bearing or hip movements 4
• Supplemental oxygen should be provided for at least 24 hours postoperatively 5
• Monitor for and prevent common complications:
  • Delirium (occurs in 25% of patients) 5
  • Pressure ulcers 6
  • Infection 5
  • Venous thromboembolism 5

Special Considerations

• Younger patients (under 50 years) often have different fracture patterns:

  • Ages 20-40: Commonly subtrochanteric and basicervical regions after high-energy injuries 7
  • Ages 40-50: More similar to osteoporotic-type fractures during simple falls 7

• Elderly patients require:

  • Nutritional supplementation (up to 60% are malnourished) 5
  • Evaluation and treatment of underlying osteoporosis 5
  • Removal of urinary catheters as soon as possible to reduce infection risk 5

By following these evidence-based guidelines for surgical management of hip fractures, outcomes can be optimized while minimizing complications and mortality.