Treatment

Timing of surgery

• perform surgery on the day of, or the day after, admission
  
  
• identify and treat correctable comorbidities immediately so that surgery is not delayed by:
  • anaemia
  • anticoagulation
  • volume depletion
  • electrolyte imbalance
  • uncontrolled diabetes
  • uncontrolled heart failure
  • correctable cardiac arrhythmia or ischaemia
  • acute chest infection
  • exacerbation of chronic chest conditions

Surgical procedures

• offer replacement arthroplasty (total hip replacement or hemiarthroplasty) to patients with a displaced intracapsular hip fracture
  
  
• offer total hip replacements to patients with a displaced intracapsular fracture who:
  • were able to walk independently out of doors with no more than the use of a stick and are
  • not cognitively impaired
  • and are medically fit for anaesthesia and the procedure
    
    
• use a proven femoral stem design rather than Austin Moore or Thompson stems for arthroplasties
  
  
• use cemented implants in patients undergoing surgery with arthroplasty
  
  
• consider an anterolateral approach in favour of a posterior approach when inserting a hemiarthroplasty
  
  
• use extramedullary implants such as a sliding hip screw in preference to an intramedullary nail in patients with trochanteric fractures above and including the lesser trochanter (AO classification types A1 and A2)
  
  
• use an intramedullary nail to treat patients with a subtrochanteric fracture

Reference:

• NICE (May 2017). Hip fracture.