Diagnosis

• Offer magnetic resonance imaging (MRI) if hip fracture is suspected despite negative X-rays

Investigation

• n/a

Management

• Ensure the following co-morbidities are corrected to ensure surgery not delayed: Anaemia; Anti-coagulation; Volume depletion; Electrolyte imbalance; Uncontrolled diabetes; Uncontrolled heart failure or arrhythmia; Acute or exacerbation of chest infection
• Analgesia
  • Assess patients’ pain immediately upon presentation, then 30 mins, then hrly till settled on ward then regularly as part of nursing observation
  • Analgesia should be sufficient to allow joint manipulation for assessment
  • Paracetamol 6 hrly pre-operatively unless contra-indicated
  • Opioids if Paracetamol ineffective
  • NSAIDs are not recommended
• Anaesthesia: Offer Ga or spinal discussing risk / benefits

Surgical Procedures

• Displaced intracapsular fracture: Offer replacement arthroplasty either hemiarthroplasty or Total Hip Replacement
• THR: if able to walk independently, not cognitively impaired, medically fit for anaesthesia
• By inference: cemented arthroplasty reserved for very elderly / immobile (or unfit for prolonged GA)
• Arthroplasty: Use proven femoral stem design rather than Austin Moore or Thompson stems
• Undisplaced: fixation with screws (arthroplasty for those patients who are less fit)
• Trochanteric fractures (above and including the lesser trochanter): Use extramedullary implants such as a sliding (dynamic) hip screw in preference to an intramedullary nail
• Subtrochanteric fracture including femoral shaft fracture: Use an intramedullary nail

NICE Source: CG124 Hip fracture: management. Summary compiled by Dr D P Sheppard MBBS.