From the Guidelines
The latest UK guidelines for neck of femur fracture management emphasize prompt surgical intervention within 24 hours of admission, ideally after medical optimization, with a preference for spinal anaesthesia co-administered with nerve block and minimal sedation, as recommended by the Association of Anaesthetists in 2021 1.
Key Recommendations
- Prompt surgical intervention within 24 hours of admission is crucial to reduce morbidity and mortality, with a multidisciplinary approach involving orthogeriatricians, orthopedic surgeons, physiotherapists, and social care 1.
- Pain management should include regular paracetamol and consideration of nerve blocks, with cautious use of opioids 1.
- Surgical options depend on fracture type, with displaced intracapsular fractures typically requiring arthroplasty and extracapsular fractures requiring fixation with sliding hip screws or intramedullary nails.
- Postoperatively, patients should begin mobilization within 24 hours with physiotherapy support, receive thromboprophylaxis, and undergo falls risk assessment 1.
Multidisciplinary Approach
- A multidisciplinary approach is essential to reduce mortality and improve functional outcomes, as hip fractures carry significant mortality risk and often lead to loss of independence 1.
- Orthogeriatricians, orthopedic surgeons, physiotherapists, and social care should work together to provide comprehensive care, including medical optimization, surgical intervention, and rehabilitation.
Secondary Prevention
- Secondary prevention includes calcium and vitamin D supplementation, with consideration of anti-osteoporotic medications like bisphosphonates, to reduce the risk of further fractures 1.
From the Research
Current Guidelines for Femur Fracture Management in the UK
The management of femur fractures, particularly in the elderly population, is a critical aspect of orthopedic care. Recent studies have provided insights into the optimal treatment strategies for these injuries.
Treatment Options
- Internal fixation (IF) with cannulated screws is a widely accepted method for treating nondisplaced femoral neck fractures in elderly patients 2.
- Hemiarthroplasty (HA) is another treatment option that has shown merits in reducing surgical complications and reoperations compared to IF 2, 3, 4.
- Total hip arthroplasty (THA) may be considered for select active elderly patients with displaced femoral neck fractures 5.
Comparison of Treatment Outcomes
- A multicenter randomized controlled trial found that HA led to improved mobility and fewer major reoperations compared to screw fixation in elderly patients with nondisplaced femoral neck fractures 3.
- A systematic review and meta-analysis found that HA had a lower implant-related complication rate, lower reoperation rate, and superior hip function compared to screw fixation in elderly patients with undisplaced femoral neck fractures 4.
- Another study found that HA decreased re-operation rate, while IF decreased operative time, blood loss, and infection risk 5.
Recommendations
- For non-displaced fractures, both internal fixation and hemiarthroplasty remain feasible options 5.
- For displaced fractures, the literature strongly supports arthroplasty, with most elderly patients being managed with a hemiarthroplasty 5.
- Cemented arthroplasty decreases periprosthetic fracture risk compared to cementless arthroplasty 5.