Hip fracture: The management of hip fracture in adults

NICE guidelines [CG124] Published date:

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.

  • NICE has accredited the process used by the Centre for Clinical Practice at NICE to produce guidelines. Accreditation is valid for 5 years from September 2009 and applies to guidelines produced since April 2007 using the processes described in NICE's 'The guidelines manual' (2007, updated 2009). More information on accreditation can be viewed at www.nice.org.uk/accreditation
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