American Academy of Orthopaedic Surgeons
Management of Hip Fractures in Older Adults
This guideline holds 16 recommendations, 212 references, 2 tables and 1 figure.
Summary
This guideline offers evidence-based recommendations for the surgical and perioperative management of hip fractures in older adults. It focuses on aspects such as optimal surgical timing, venous thromboembolism prophylaxis, multimodal analgesia, surgical approaches, and the efficacy of interdisciplinary care programs in improving patient outcomes.
Key takeaways
Preoperative traction should not routinely be used.
Surgery within 24-48 hours may lead to better outcomes.
VTE prophylaxis should be used for hip fracture patients.
Arthroplasty is recommended over fixation for unstable femoral neck fractures.
Cemented femoral stems should be used in patients undergoing arthroplasty.
Cephalomedullary devices are recommended for subtrochanteric, reverse obliquity, and unstable intertrochanteric fractures.
Tranexamic acid administration reduces blood loss and blood transfusion needs.
Multimodal analgesia with preoperative nerve blocks improves postoperative pain.
Interdisciplinary care programs should be utilized to decrease complications and improve outcomes.
What is new in this version
This CPG replaces the 1st edition (2014). Key changes include the adoption of the GRADE Evidence-to-Decision Framework, assigning all observational studies a base appraisal of low-quality evidence, updating study appraisal methodology (coinciding with Cochrane, ROBINs, QUADAS, QUIPs), and mandating a sample size of >= 30 per comparison group with an average participant age of at least 65 years.
