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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
Daniel J Sullivan, MD, MPH


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 older adults are declining in the United States, possibly due to a concurrent rise in bisphosphonate use [3].

Hip fracture is associated with increased mortality rates for both the short term (three to six months) and the long term (5 to 10 years) [4]. A meta-analysis of prospective cohort studies found a five- to eightfold 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 10 years following the fracture. Of those who survive to six months, only 60 percent recover their pre-fracture walking ability and only 50 percent recover their pre-fracture 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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