Home » 4) The Hip Fracture Patient

4) The Hip Fracture Patient

Guiding Question:
why are elderly hip fracture patients at higher risk of bad perioperative outcomes than elderly non-hip fracture surgical patients?

 

Hip fracture is associated with increased short and long term mortality. Many patients never achieve full functional recovery. Medical consultation is important in these patients for risk assessment, determination of treatment goals, and prevention and management of postoperative complications.

 

Learning objectives:

  • Perform a comprehensive assessment of the older hip fracture patient
  • Initiate strategies to prevent perioperative complications in the hip fracture patient

 

It is important for medical consultants to understand the differences between femoral neck, intertrochanteric and trochanteric hip fractures and their management. UpToDate nicely summarizes this topic.  Focus on whether they are intracapsular or extracapsular and, in general, the surgical approach to each. This will be important as you help the patient and the surgeon decide upon goals of care.

The preoperative evaluation of the older patient tends to be more complex that that of the younger patient.  In addition to evaluating cardiac and pulmonary risk you must also evaluate:

  • cognitive capacity
  • risk factors for delerium
  • functional status
  • frailty
  • nutritional status
  • life expectancy
  • treatment goals and expectations (including advanced directives)
  • family and social support

Watch this interactive eduCanon video on preoperative evaluation of the older patient. You will have to register for a free eduCanon account to watch it. Sign up as a student.

Learning Resources:
Readings:

  1. Preoperative Assessment of the Older Patient: A Narrative Review (Not specific to hip fracture but presents a stepwise approach to geriatric preoperative assessment)
  2. Optimal Preoperative Assessment of the Geriatric Surgical Patient: A Best Practices Guideline (most useful for the tools contained in the figures)
  3. UpToDate chapter on Medical Consultation for Patients with Hip Fracture

Videos: (total viewing time)

  1. Preoperative Assessment of the Older Patient (6:43)

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