Femoral fractures – Related resources

Cochrane reviews

• No clear conclusions can be made on the choice of implant for internal fixation of intracapsular fractures .
• Intermittent pneumatic compression may reduce the risk of deep vein thrombosis in postoperative patients .
• Multidisciplinary inpatient rehabilitation for older people after hip fracture surgery may improve activities of daily living and mobility in the short term but does probably not improve overall outcome or reduce mortality .
• Oral protein and energy feeds may have some beneficial effects during hip fracture aftercare but overall the evidence for the effectiveness of nutritional supplementation is weak .
• In the treatment of a hip fracture with arthroplasty, cementing the prosthesis in place may reduce post-operative pain and lead to better mobility as compared to uncemented prosthesis .
• Operative management of extracapsular femoral fractures may reduce the length of hospital stay and improve rehabilitation as compared to conservative management by traction .
• A programme of proactive geriatric consultation may reduce delirium incidence and severity in patients undergoing surgery for hip fracture .
• Traction prior to surgery for a hip fracture may not provide any benefit in terms of relief of pain or success of fracture reduction .
• Internal fixation appears to be associated with less initial operative trauma but with an increased risk of re-operation on the hip as compared with arthroplasty in the treatment intracapsular femoral fractures in adults. Both procedures have their own inherent complications .
• There is insufficient evidence from randomised trials to determine whether replacement arthroplasty has any advantage over internal fixation for extracapsular hip fractures .
• The sliding hip screw may be preferable to fixed nail plates for fixing extracapsular hip fracture in adults .
• The use of nerve blocks inserted either before or at the time of surgery of hip fracture appears to reduce the degree of pain, the need for parenteral analgesia, and the risk of cardiac complications .

Other evidence summaries

• Threaded acetabular cups may have a higher failure rate than cemented or porous in-growth cups .
• The greatest volume of evidence is available for the Charnley prosthesis. The use of more expensive (cementless) prostheses is hard to justify on current evidence .
• Arthroplasty may be associated with fewer secondary major operations than internal fixation in the treatment of displaced fractures of the femoral neck .
• Screws appear to be preferable to smooth pins for internal fixation of femoral neck fractures .
• Geriatric hip fracture programmes and early supported discharge may shorten the average length of hospital stay and increase rates of return to previous residential status .

Literature

• Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures. J Am Acad Orthop Surg 2008 Oct;16(10):596-607.
• Kaplan K, Miyamoto R, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. II: intertrochanteric fractures. J Am Acad Orthop Surg 2008 Nov;16(11):665-73.
• Kannus P, Parkkari J, Niemi S, Pasanen M, Palvanen M, Järvinen M, Vuori I. Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med 2000 Nov 23;343(21):1506-13.