Clinical Review

Evidence based case report Managing an elderly patient with a fractured femur

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7227.102 (Published 08 January 2000) Cite this as: BMJ 2000;320:102
  1. Martyn J Parker, research fellow ([email protected])
  1. Orthopaedic Department, Peterborough District Hospital, Peterborough PE3 6DA
  • Accepted 19 April 1999

My patient, an elderly woman, had been admitted to the trauma ward via the accident and emergency department on the previous day because she had sustained a trochanteric fracture of the left hip after a simple fall at home. She was in average health for someone of 82 and had a medical history that included hypertension, a myocardial infarction (three years previously), and a fractured wrist (eight years before). Since her husband's death she had lived alone in sheltered accommodation.

I needed to establish the extent to which her management could be evidence based and, where possible, to determine the optimum management using evidence based medicine. I also decided that I could spare no more than four hours to identify the evidence and that I should be able to do this from my office computer.

The search

I used Medline, the Cochrane Library1 and Best Evidence2 (both on CD Rom), and the following internet sites: the NHS Centre for Reviews and Dissemination (nhscrd.york.ac.uk), the American Academy of Orthopedic Surgeons (www.aaos.org), Omni (www.omni.ac.uk), the Trip Database (http://www.ceres.uwcm.ac.uk/frameset.cfm?section=trip), the Scottish Intercollegiate Guidelines Network (SIGN; www.show.scot.nhs.uk/sign/home.htm), and Bandolier (www.jr2.ox.ac.uk/Bandolier). Unless otherwise indicated, I used the search term “hip fracture.” I found …

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