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Medical consultation for patients with hip fracture

INTRODUCTION

More than 270,000 hip fractures occur annually in the United States; this number is projected to increase substantially in the coming decades with predicted shifts in the population age [1]. Mortality from hip fracture approaches 25 percent at one year [2]. 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 [3].

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) [4] to 30 percent within six months (for a group predominantly female) [5]. Early readmission correlated with medical comorbidities including fluid and electrolyte problems, renal insufficiency, and underlying cardiac and pulmonary disease [4].

Hip fracture is typically considered a surgical disease. However, medical consultants are almost universally involved in the care of these patients [6]. 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
  • Prophylactic antibiotics
  • Thromboembolic prophylaxis
  • Prevention and management of delirium
  • Assessment for underlying osteoporosis

TIMING OF SURGICAL INTERVENTION

The timing of surgery in patients with hip fracture, although ultimately set by the surgeon, is often dictated by the preoperative medical evaluation. Timing of the surgical intervention may have an important impact upon patient outcomes [7]:
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