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27-12-2011 | Surgery | Article

Working group highlights key factors in hip fracture surgery


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MedWire News: Hip fracture patients should be treated surgically within 24 to 48 hours following the injury and all femoral neck fractures in geriatric patients should be treated with hip replacement.

These are just some of the recommendations of an international working group highlighting some of the important factors in the surgical treatment and management of hip fracture patients.

The group notes that delays beyond 48 hours after admission may increase the risk for death at 30 days and 1 year in hip fracture patients.

The current consensus is that patients with undisplaced femoral neck fractures should be treated surgically, but the optimum treatment of displaced femoral neck fractures and trochanteric fractures remains controversial, state Antonio Moroni (University of Bologna, Italy) and colleagues in Archives of Orthopaedic and Trauma Surgery.

According to the working group, specialized centers that integrate orthopedic surgeons, geriatricians, rheumatologists, and psychiatrists are needed in order to enhance patient care following surgery.

These centers would be particularly helpful when treating patients with dementia, "as orthopedic surgeons relate poorly to such medical issues," note Moroni and colleagues.

The working group also highlighted the importance of surgical technique in treating fractures, including the implant, but point out that there have been no improvements in implant design in the past 50 years.

"As a consequence, malunion has become unjustifiably accepted," writes the working group.

In North America and Europe, the sliding hip screw (SHS) is used in approximately 70% to 80% of all patients. A newer implant, the intramedullary hip screw (IMHS) is often not used as surgeons have limited training using it.

For surgeons using implanting a SHS, approximately 200 to 300 operations are needed before proficiency is achieved, state Moroni and colleagues.

In terms of secondary prevention, the working group states that it should begin when the patients is in the acute care hospital and continue upon discharge with the family physician.

Dual-energy X-ray absorptiometry and pharmacologic treatment should also be part of follow-up care.

By MedWire Reporters

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