Published online Sep 18, 2014. doi: 10.5312/wjo.v5.i4.402
Revised: May 14, 2014
Accepted: May 28, 2014
Published online: September 18, 2014
Nowadays, fracture surgery represents a big part of the orthopedic surgeon workload, and usually has associated major clinical and social cost implications. These fractures have several complications. Some of these are medical, and other related to the surgical treatment itself. Medical complications may affect around 20% of patients with hip fracture. Cognitive and neurological alterations, cardiopulmonary affections (alone or combined), venous thromboembolism, gastrointestinal tract bleeding, urinary tract complications, perioperative anemia, electrolytic and metabolic disorders, and pressure scars are the most important medical complications after hip surgery in terms of frequency, increase of length of stay and perioperative mortality. Complications arising from hip fracture surgery are fairly common, and vary depending on whether the fracture is intracapsular or extracapsular. The main problems in intracapsular fractures are biological: vascularization of the femoral head, and lack of periosteum -a major contributor to fracture healing- in the femoral neck. In extracapsular fractures, by contrast, the problem is mechanical, and relates to load-bearing. Early surgical fixation, the role of anti-thromboembolic and anti-infective prophylaxis, good pain control at the perioperative, detection and management of delirium, correct urinary tract management, avoidance of malnutrition, vitamin D supplementation, osteoporosis treatment and advancement of early mobilization to improve functional recovery and falls prevention are basic recommendations for an optimal maintenance of hip fractured patients.
Core tip: Over 90% of hip fracture patients are older than 65-year-old and have preexisting medical comorbidities. Both factors have an important influence in its prognosis and treatment. Even with optimal care, elderly trauma patients suffer a higher morbidity and mortality rate when compared with the general population, and often demand for expensive hospital aftercare. Because of that, surgical treatment of hip fracture in these patients has exceptional clinical challenges, and needs strategies to optimize patient care. Acute orthogeriatric units, with medical co-management of these patients, offer the best chance for a successful outcome.