The management of hip fracture in older adults
To minimise the impact on the individual as well as the healthcare system, it is important that decisions about hip fracture management are based on reliable and robust evidence. Recently NIHR funded a Systematic Reviews Programme of work to develop a suite of Reviews that would provide up to date evidence to support clinical decision makers and health technology appraisal organisations such as NICE in the development of guidance.
This special collection highlights Reviews in the Cochrane Library from Cochrane Anaesthesia, Cochrane Bone, Joint and Muscle Trauma, Cochrane Dementia and Cognitive Improvement and Cochrane Vascular. It includes those funded by this programme as well as other Reviews of interventions and strategies relevant across the recovery journey for people with hip fracture.
These two reviews assessed common interventions used in the perioperative period: treatments to prevent bleeding as a consequence of both injury and surgical intervention and to prevent venous thromboembolism, as well as the effectiveness of advanced methods to manage fluid therapy during this period.
Anticoagulants to reduce the risk of VTE
Fluid management following hip fracture
Anaesthesia and Analgesia
- General anaesthesia (using inhalational agents, or total intravenous anaesthesia).
- Neuraxial blocks (epidural, spinal, or combined epidural/spinal).
- Peripheral nerve blocks (posterior lumbar (psoas) plexus blocks, with or without sacral plexus blocks, or any other peripheral nerve blocks).
Nerve blocks for hip fracture
Anaesthesia for hip fracture surgery
- Internal fixation with pins, screws, and fixed angle plates.
- Arthroplasties fixed in place with or without bone cement using hemiarthroplasties (bipolar or unipolar), and total hip arthroplasties (single or dual-mobility articulation).
- Non-operative treatment.
Internal fixation for intracapsular fractures
Arthroplasties for hip fractures
Surgical treatments for intracapsular fractures: a NMA
Nails versus plates for extracapsular fractures
Surgical treatments for extracapsular fractures: a NMA
These reviews considered the additional support that people may need whilst recovering from surgery – either whilst still in hospital or after discharge. They also looked specifically at the additional needs in this patient group, who may be malnourished at the time of their fracture or have poor food intake whilst in hospital, or who may have dementia.