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Medical consultation for patients with hip fracture

R Sean Morrison, MD
Albert L Siu, MD, MSPH
Section Editor
Kenneth E Schmader, MD
Deputy Editor
H Nancy Sokol, MD


A total of 310,000 individuals were hospitalized with hip fractures in the United States in 2003 [1]. Worldwide, the incidence of hip fracture exceeds 1.6 million adults annually [2]. Hip fracture rates among the elderly are declining in the US, possibly due to a concurrent rise in bisphosphonate use [3].

Hip fracture is associated with increased mortality rates for both the short-term (3 to 6 months) and long-term (5 to 10 years) [4]. A meta-analysis of prospective cohort studies found a five- to eight-fold increase in mortality rates within three months of fracture; this comparative increase relative to age-matched controls without a history of hip fracture lessened but persisted ten years following the fracture. Of those who survive to six months, only 60 percent recover their prefracture walking ability and only 50 percent recover their prefracture ability to perform activities of daily living [5].

Hospital readmission rates after initial treatment for hip fracture range from 20 percent within 30 days of discharge (for a predominantly male group of veterans) [6] to 30 percent within six months (for a group predominantly female) [7]. Early readmission correlated with medical comorbidities including fluid and electrolyte problems, renal insufficiency, and underlying cardiac and pulmonary disease [6].

Hip fracture is typically considered a surgical disease. However, medical consultants are almost universally involved in the care of these patients [8]. Medical consultation is associated with improved one year mortality for patients hospitalized with hip fracture [9]. This topic will review the most common decisions that medical consultants are asked to make in the care of the patient with hip fracture. In particular, we will focus on:

Timing of surgical intervention


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