New developments in hip fracture treatment

Abstract

With current surgical and anaesthetic methods almost all hip fractures should be treated surgically. Delays to surgery continue to be reduced, although the optimum timing for surgery remains controversial. More intensive or specialized perioperative care, particularly for fluid resuscitation and analgesia, may improve outcome. Many of the implants used have not changed much over the last 50 years, but there have been considerable improvements in surgical technique. For intracapsular fractures there is little evidence to suggest that total hip replacements or bipolars have any advantage over the traditional hemiarthroplasties. For trochanteric fractures the sliding hip screw remains the implant of choice, although the newer intramedullary nails are valuable for more specific fracture types and their use will become more common. After surgery the majority of patients should be allowed to mobilize without any restrictions on weight bearing or hip movements. Optimum surgical rehabilitation should enable the majority of patients to be able to go home with hospital stays of less than two weeks.