Key priorities for implementation

Key priorities for implementation

Timing of surgery

  • Perform surgery on the day of, or the day after, admission.

  • Identify and treat correctable comorbidities immediately so that surgery is not delayed by:

    • anaemia

    • anticoagulation

    • volume depletion

    • electrolyte imbalance

    • uncontrolled diabetes

    • uncontrolled heart failure

    • correctable cardiac arrhythmia or ischaemia

    • acute chest infection

    • exacerbation of chronic chest conditions.

Planning the theatre team

  • Schedule hip fracture surgery on a planned trauma list.

Surgical procedures

  • Perform replacement arthroplasty (hemiarthroplasty or total hip replacement) in patients with a displaced intracapsular fracture.

  • Offer total hip replacements to patients with a displaced intracapsular fracture who:

    • were able to walk independently out of doors with no more than the use of a stick and

    • are not cognitively impaired and

    • are medically fit for anaesthesia and the procedure.

  • Use extramedullary implants such as a sliding hip screw in preference to an intramedullary nail in patients with trochanteric fractures above and including the lesser trochanter (AO classification types A1 and A2).

Mobilisation strategies

  • Offer patients a physiotherapy assessment and, unless medically or surgically contraindicated, mobilisation on the day after surgery.

  • Offer patients mobilisation at least once a day and ensure regular physiotherapy review.

Multidisciplinary management

  • From admission, offer patients a formal, acute orthogeriatric or orthopaedic ward-based Hip Fracture Programme that includes all of the following:

    • orthogeriatric assessment

    • rapid optimisation of fitness for surgery

    • early identification of individual goals for multidisciplinary rehabilitation to recover mobility and independence, and to facilitate return to pre-fracture residence and long-term wellbeing

    • continued, coordinated, orthogeriatric and multidisciplinary review

    • liaison or integration with related services, particularly mental health, falls prevention, bone health, primary care and social services

    • clinical and service governance responsibility for all stages of the pathway of care and rehabilitation, including those delivered in the community.

  • Consider early supported discharge as part of the Hip Fracture Programme, provided the Hip Fracture Programme multidisciplinary team remains involved, and the patient:

    • is medically stable and

    • has the mental ability to participate in continued rehabilitation and

    • is able to transfer and mobilise short distances and

    • has not yet achieved their full rehabilitation potential, as discussed with the patient, carer and family.

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