Clinical Review Extracts from “Clinical Evidence”

Hip fracture

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7292.968 (Published 21 April 2001) Cite this as: BMJ 2001;322:968
  1. William John Gillespie (bill.gillespie@stonebow.otago.ac.nz), professor
  1. Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

    Background

    Definition Hip fracture is a fracture of the femur above a point 5 cm below the distal part of the lesser trochanter.1 Intracapsular fractures occur proximal to the point at which the hip joint capsule attaches to the femur. Undisplaced fractures include impacted or adduction fractures. Displaced intracapsular fractures may be associated with disruption of the blood supply to the head of the femur. Numerous subdivisions and classification methods exist for these fractures. In the most distal part of the proximal femoral segment (below the lesser trochanter), the term subtrochanteric is used. Extracapsular fractures occur distal to the hip joint capsule.

    Intervention

    Beneficial:

    Sliding hip screw device for internal fixation of extracapsular fracture

    Antibiotic prophylaxis before surgery

    Mattress on operating tables to prevent pressure sores

    Likely to be beneficial:

    Regional anaesthesia for surgery

    Arthroplasty for displaced intracapsular fracture

    Postoperative prophylaxis with heparin to reduce venous thromboembolism

    Postoperative prophylaxis with antiplatelet agents to reduce venous thromboembolism

    Postoperative prophylactic cyclical compression of the foot or calf to reduce venous thromboembolism

    Nutritional supplementation after fracture

    Geriatric hip fracture programmes in acute orthopaedic units

    Trade off between benefits and harms:

    Early supported discharge programmes

    Unknown effectiveness:

    Arthroplasty for extracapsular hip fracture

    Nerve blocks for pain control

    Use of graduated elastic compression to prevent venous thromboembolism

    Specialised orthopaedic rehabilitation units for elderly people

    Systematic home based rehabilitation

    Unlikely to be beneficial:

    Conservation (non-surgical) treatment of extracapsular fractures

    Preoperative bed traction to the injured limb

    Likely to be ineffective or harmful:

    Intramedullary fixation with cephalocondylic nail for extracapsular fracture (less effective or more harmful than sliding hip screw)

    Intramedullary fixation with condylocephalic nail for extracapsular fracture

    Incidence/prevalence Hip fractures may occur at any age but are most common in elderly people. In industrialised societies, the lifetime risk of hip fracture is about 18% in women and …

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