Management of Hip Fractures in Older Adults

Patient Guideline Summary

Publication Date: December 3, 2021

Last Updated: March 3, 2023

Objective

This patient summary means to summarize key recommendations from the American Academy of Orthopedic Surgeons (AAOS) for management of hip fractures in older adults.

Overview

Hip fractures in older adults are usually associated with diseases that weaken the bone like osteoporosis or cancers. Other conditions, such as history of falls or frailty (being weak when getting old), may also raise hip fracture risk.

Some of the most common risk factors for older adult hip fracture are increasing age, low bone density, impaired balance, gait disturbance, poor vision, and hazardous living environments (such as crowded spaces, throw rugs, or a lack of grab bars when needed), race and ethnicity.

Management

Hip fracture surgery within 24-48 hours of entrance the hospital may be associated with better results.
Your doctor will probably give you venous thromboembolism (VTE) prophylaxis (drugs to prevent blood clotting) if you have a hip fracture. This is because there are many risk factors for developing VTE in older patients with hip fracture including the old age and the surgery.
You may receive either spinal or general anesthesia if you have a hip fracture.
If you have an unstable (displaced) femoral neck fracture, you may need an arthroplasty (joint replacement surgery).
- Arthroplasty may cost more than internal fixation due to costly implants, but this is generally compensated for by a decrease in the cost of reoperations that is occasionally required when internal fixation fails.
There are several different kinds of arthroplasty. Your orthopedic surgeon will discuss the options and recommend the one best for you.
You may receive a blood transfusion after hip fracture surgery.
You may receive a specific type of analgesia (an injection to decrease pain without loss of consciousness) to treat pain after hip fracture.
Your doctor may give you a drug called tranexamic acid to reduce blood loss and blood transfusion if you have a hip fracture.
Your care before, during and after surgery will involve several specialists beside the surgeon and the anesthesiologist such as geriatric and orthopedic providers, nursing, dietary, and rehabilitation providers such as occupational and physical therapists to decrease complications, hasten recovery and improve your outcomes.
Following surgical treatment of your hip fractures, your doctor may suggest immediate, full weight bearing (when you place all of your weight on the operated leg) to tolerance (if you are able).

Abbreviations

AAOS: American Academy Of Orthopedic Surgeons
VTE: Venous Thromboembolism

Source Citation

American Academy of Orthopaedic Surgeons Management of Hip Fractures in Older Adults Evidence-Based Clinical Practice Guideline. https://www.aaos.org/hipfxcpg.pdf Published December 3, 2021.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.