1. By Rachel Brown

2. Why do we need guidelines?
Ageing population increasing prevalence – 70,000-
75,000 hip fractures/year
Cost to NHS = £2 billion a year
10% of people with hip fractures die within 1 month
1 in 3 patients die within 1 year of fracture

3. What needs to be considered?
Timing
Analgesia
Anaesthesia
Surgical procedure
Mobilisation post-op
Patient and carer info

4. Timing
Perform surgery on day of, or day after, admission
Identify and treat co-morbidities immediately so as
not to delay surgery:
Anaemia, anticoagulation, volume depletion,
electrolyte imbalance, diabetes, HF, cardiac
arrhythmia, acute chest infection, exacerbation of
chronic chest condition

5. Analgesia
Assess pain – on admission, 30 mins after analgesia
administration, hourly until patient settled, regularly
Give analgesia to - allow movements necessary for Ix,
nursing care and rehab
Paracetamol 6 hourly pre-op, additional opioid if
insufficient (nerve block if opioid analgesia insufficent)
Paracetamol 6 hourly post-op, additional opioid if
insufficient
NSAIDs not recommended

6. Anaesthesia
Discuss risks and benefits with patient. Decide on
general vs. spinal anaesthesia

7. Surgical Procedure
Main aim – allow to weight bear immediately post-op
Options:
1. Internal fixation – intramedullary nail, sliding hip
screw
2.Hemiarthroplasty
3. Total arthroplasty

8. Internal Fixation
Used when
fracture is:
non-displaced
and
intracapsular;
extra-capsular
Hip screw for
trochanteric
Nail for sub-
trochanteric

9. Hemi-arthroplasty vs. Total
Used in displaced intra-capsular fracture
NICE recommends cement in all arthroplasties
Total hip replacement recommended in:
Patients able to walk independently outdoors with no
more than the use of one stick prior to the fall, and
those who are cognitively intact and who are medically
fit.

10. Post-op Mobilisation
ASAP
Offer patient physio assessment and mobilisation the
day after surgery
Mobilise at least once a day and offer regular physio
reviews

11. Patient and Carer Info
Give information and advise on:
o Diagnosis
o Anaesthesia
o Analgesia
o Surgical Procedure
o Complications
o Post-op care and long term outcomes
o Healthcare professionals involved