Introduction

A proximal femoral or hip fracture is the most common reason for admission to an acute orthopaedic ward. About 86 000 such fractures occur each year in the United Kingdom.^w1 Global numbers were reported as 1.3 million in 1990, and depending on secular trends could be 7-21 million by 2050.1

In developed countries, the treatment of a hip fracture requires a wide range of disciplines, as the patient will present to the ambulance service and the accident and emergency unit, then pass through departments of radiology, anaesthetics, orthopaedic surgery, medicine, and rehabilitation. Medical and social services in the community may be needed when the patient leaves hospital.

Mortality associated with a hip fracture is about 5-10% after one month. One year after fracture about a third of patients will have died, compared with an expected annual mortality of about 10% in this age group.2 3 ^w2 Thus, only a third of deaths are directly attributable to the hip fracture itself, but patients and relatives often think that the fracture has played a crucial part in the final illness.^w2

More than 10% of survivors will be unable to return to their previous residence. Most of the remainder will have some residual pain or disability.2 3

Search strategy

The musculoskeletal Cochrane review group has identified all randomised controlled trials on hip fractures and most are summarised in Cochrane reviews (http://www.cochrane.org/) and in Clinical Evidence articles.4

For aspects of hip fracture that cannot or have not been subject to randomised controlled trials, we looked at systematic review articles, the evidence based guidelines identified on this topic, and our personal libraries of hip fracture references based on annual Medline searches.5^–7

Who fractures their hip?

The average age of patients with hip fracture is over 80, and nearly 80% are women.2 …