From the Guidelines
Yes, hip fractures can cause fever, and it is essential to investigate the cause of fever, especially if it exceeds 101°F (38.3°C), to determine the appropriate treatment. After a hip fracture, patients commonly develop fever due to the inflammatory response to trauma and tissue damage 1. The body releases inflammatory mediators as part of the healing process, which can elevate body temperature. Additionally, hip fractures in elderly patients often lead to complications that cause fever, including urinary tract infections from catheterization, pneumonia from decreased mobility, or surgical site infections following repair procedures. According to the guidelines for the diagnosis and management of skin and soft tissue infections 1, surgical site infections (SSIs) are a common cause of fever in postoperative patients, and it is crucial to inspect the wound carefully to rule out signs of infection.
More seriously, fat embolism syndrome can occur 24-72 hours after fracture, presenting with fever, respiratory distress, and mental status changes. Blood clots (deep vein thrombosis or pulmonary embolism) may also develop and cause fever. The management of proximal femoral fractures 1 emphasizes the importance of monitoring patients for signs of infection, including fever, and developing protocols for the resuscitation of patients with hip fracture.
Key considerations in the management of fever in patients with hip fractures include:
- Monitoring for signs of infection, such as purulent incisional drainage, positive culture of aseptically obtained fluid or tissue, or local signs and symptoms of pain or tenderness, swelling, and erythema 1
- Investigating the cause of fever, especially if it exceeds 101°F (38.3°C), to determine the appropriate treatment
- Considering the risk of surgical site infections, urinary tract infections, pneumonia, and other complications that can cause fever in patients with hip fractures
- Developing protocols for the resuscitation of patients with hip fracture, including monitoring, cannulation, intravenous fluid therapy, analgesia, thermoregulation, and pressure care 1.
From the Research
Hip Fracture and Fever
- A hip fracture can lead to various complications, including infections that may cause fever 2, 3, 4.
- Studies have shown that patients with hip fractures are at risk of developing surgical site infections (SSI), urinary tract infections (UTI), and pneumonia, all of which can lead to sepsis and fever 4.
- Sepsis, which can be caused by UTI, pneumonia, or SSI, occurs in about 1 in 40 patients after geriatric hip fracture surgery and is associated with a higher mortality rate 4.
- While there is no direct evidence that a hip fracture itself causes fever, the risk of infection and subsequent fever is increased in patients with hip fractures, particularly in those who are elderly or have significant comorbidities 3, 5, 6.
- Maintaining normothermia and preventing hypothermia is crucial in patients with hip fractures, as poor temperature control can lead to increased complications, including infections and fever 5.