Management of Hip Fractures in the Elderly

·       Ambulatory: Able to walk 10 meters or more indoor with or without assistive device prior fracture and able to walk independently out of doors with no more than the use of a stick and do not have a condition or comorbidity that makes the procedure unsuitable for them.

·       Early mobilization:  The initiation of functional movement and physical activity as soon as medically and surgically appropriate following injury, illness, or surgery, often within the first 24–48 hours. It may include sitting, standing, transfers, and assisted ambulation depending on the patient’s condition and clinical recommendations.

·       Fragility fracture: These are fractures which result from low-energy trauma (a mechanical force that would not ordinarily cause a fracture), such as a fall from standing height or less. These fractures are the main clinical consequence of osteoporosis, although they may occur in postmenopausal women even in the absence of osteoporosis.

·       Interdisciplinary care: It is a team which consist of health care professionals from different disciplines who provide coordinated, integrated care with collectively set goals and shared resources and responsibilities.

·       Medically optimized: Cleared by anaesthesia

·       Neuraxial / deep, non-compressible procedures: spinal/epidural and deep plexus or deep peripheral blocks at non-compressible sites (treated like neuraxial for timing decisions).

·       Older patient/adult typically age 60+; however, frailty and comorbidity burden are more important than chronological age.

·       Stable femoral neck fracture: In patients with stable (impacted/non-displaced Garden’s I and II) femoral neck fractures

·       Stable trochanteric fracture: Stable trochanteric fractures are simple two-part intertrochanteric fractures with posteromedial cortical continuity and lateral wall integrity. This fracture pattern is considered stable as it will resist medial compressive loads once reduced.

·       Superficial / compressible single-shot blocks: peripheral blocks at compressible sites (e.g., fascia iliaca plane, femoral, adductor canal). Decisions should be based on site-specific bleeding risk assessment.

·       Unstable femoral neck fracture:  displaced intracapsular fractures in which the proximal fragment contains the femoral head with or without a portion of the femoral neck and contained within the capsule and radiologically confirmed Garden type III or IV.

·       Unstable trochanteric fracture: Unstable trochanteric fractures are fractures with comminution, posteromedial fragment, deficient lateral wall, reversed oblique, and subtrochanteric extension. This fracture pattern is considered unstable as it will drift into varus and/or medialization with exposure to compressive loads.