Management of proximal femoral fractures 2011: Association of Anaesthetists of Great Britain and Ireland

Membership of the Working Party, R Griffiths, J Alper, A Beckingsale, D Goldhill, G Heyburn, J Holloway, E Leaper, M Parker, S Ridgway, S White, M Wiese, I Wilson, Membership of the Working Party, R Griffiths, J Alper, A Beckingsale, D Goldhill, G Heyburn, J Holloway, E Leaper, M Parker, S Ridgway, S White, M Wiese, I Wilson

Abstract

There should be protocol-driven, fast-track admission of patients with hip fractures through the emergency department. Patients with hip fractures require multidisciplinary care, led by orthogeriatricians. Surgery is the best analgesic for hip fractures. Surgical repair of hip fractures should occur within 48 hours of hospital admission. Surgery and anaesthesia must be undertaken by appropriately experienced surgeons and anaesthetists. There must be high-quality communication between clinicians and allied health professionals. Early mobilisation is a key part of the management of patients with hip fractures. Pre-operative management should include consideration of planning for discharge from hospital. Measures should be taken to prevent secondary falls. 10. Continuous audit and targeted research is required in order to inform and improve the management of patients with hip fracture.

Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

References

    1. Scottish Intercollegiate Guidelines Network. Management of hip fracture in older people. National clinical guideline 111. 2009. (accessed 30/08/2011).
    1. British Orthopaedic Association and British Geriatrics Society. The care of patients with fragility fracture. 2007. (accessed 30/08/2011).
    1. Royal College of Physicians. National clinical audit of falls and bone health in older people. November, 2007. (accessed 30/08/2011).
    1. National Confidential Enquiry into Patient Outcome and Death. An age old problem. A review of the care received by elderly patients undergoing surgery. (accessed 30/08/2011).
    1. The National Institute for Health and Clinical Excellence. Clinical Guideline 124. The management of hip fracture in adults. 2011. (accessed 30/08/2011).
    1. The National Hip Fracture Database. National Report, 2011. (accessed 30/08/2011).
    1. White SM, Griffiths R, Holloway J, Shannon A. Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Anaesthesia 2010; 65: 243-8.
    1. Hayes WC, Myers ER, Robinovitch SN, Van Den Kroonenberg A, Courtney AC, McMahon TA. Etiology and prevention of age-related hip fractures. Bone 1996; 18: S77-86.
    1. NHS Institute for Innovation and Improvement. Delivering Quality and Value. November, 2005. (accessed 30/08/2011).
    1. British Orthopaedic Association Standards for Trauma (BOAST) 1. Hip fracture in the older person. September, 2007. (accessed 30/08/2011).
    1. Royal College of Physicians, British Geriatrics Society and The British Pain Society. The assessment of pain in older people. October, 2007. (accessed 30/08/2011).
    1. Cuvillon P, Ripart J, Debureaux S, et al. Analgesia after hip fracture repair in elderly patients: the effect of a continuous femoral nerve block: a prospective and randomised study. Annales Francaises d’Anesthesie et de Reanimation 2007; 26: 2-9.
    1. White SM, Rashid N, Chakladar A. An analysis of renal dysfunction in 1511 patients with fractured neck of femur: the implications for perioperative analgesia. Anaesthesia 2009; 64: 1061-5.
    1. Foss NB, Kristensen BB, Bundgaard M, et al. Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial. Anesthesiology 2007; 106: 773-8.
    1. Parker MJ, Griffiths R, Appadu BN. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database of Systematic Reviews 2002; 1: CD001159.
    1. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. British Medical Journal 2005; 331: 1374-9.
    1. Maxwell MJ, Moran CG, Moppett IK. Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery. British Journal of Anaesthesia 2008; 101: 511-7.
    1. White SM. Including the very elderly in clinical trials. Anaesthesia 2010; 65: 778-80.
    1. Foss NB, Kristensen MT, Jensen PS, Palm H, Krasheninnikoff M, Kehlet H. The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery. Transfusion 2009; 49: 227-34.
    1. Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Regional Anesthesia and Pain Medicine 2003; 28: 172-97.
    1. Hallgren MA, Hogberg P, Andreasson S. Alcohol consumption and harm among elderly Europeans: falling between the cracks. European Journal of Public Health 2010; 20: 616-7.
    1. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Guidelines for the management of atrial fibrillation. European Heart Journal 2010; 31: 2369-429.
    1. Chambers J. Aortic stenosis: is common but often unrecognised. British Medical Journal 2005; 330: 801-2.
    1. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis and meta-regression. Canadian Journal of Anesthesia 2008; 55: 146-54.
    1. Khan SK, Kalra S, Khanna A, Thiruvengada MM, Parker MJ. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients. Injury 2009; 40: 692-7.
    1. White SM, Baldwin TJ. The Mental Capacity Act, 2005. Implications for anaesthesia and intensive care. Anaesthesia 2006; 61: 381-9.
    1. British Medical Association, Resuscitation Council (UK) and the Royal College of Nursing. Decisions relating to cardiopulmonary resuscitation. October, 2007. (accessed 30/08/2011).
    1. Association of Anaesthetists of Great Britain and Ireland. DNAR decisions in the perioperative period. May, 2009. (accessed 30/08/2011).
    1. Parker MJ, Handoll HHG, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database of Systematic Reviews 2004; 18: CD000521.
    1. Luger TJ, Kammerlander C, Gosch M, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter. Osteoporosis International 2010; 21: S555-72.
    1. Association of Anaesthetists of Great Britain and Ireland. Anaesthesia and perioperative care of the elderly. December 2001. (accessed 30/08/2011).
    1. Wood R, White SM. Anaesthesia for 1131 patients undergoing proximal femoral fracture repair: effects on blood pressure, fluid administration and perioperative anaemia. Anaesthesia 2011; 66: 1017-22.
    1. Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine-fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anesthesiology 2000; 92: 6-10.
    1. Hindle A. Intrathecal opioids in the management of acute postoperative pain. Continuing Education in Anaesthesia, Critical Care and Pain 2008; 8: 81-5.
    1. Association of Anaesthetists of Great Britain and Ireland. Recommendations for standards of monitoring during anaesthesia and recovery. 4th ed. March 2007. (accessed 30/08/2011).
    1. National Confidential Enquiry into Perioperative Deaths. Extremes of age. November, 1999. (accessed 30/08/2011).
    1. Minville V, Asehnoune K, Salau S, et al. The effects of spinal anesthesia on cerebral blood flow in the very elderly. Anesthesia and Analgesia 2009; 108: 1291-4.
    1. National Institute for Health and Clinical Excellence. Clinical guideline 92. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. March, 2010. (accessed 30/08/2011).
    1. National Institute for Health and Clinical Excellence. Clinical guideline 65. Inadvertent perioperative hypothermia: the management of inadvertent perioperative hypothermia in adults. April, 2008. (accessed 30/08/2011).
    1. Price JD, Sear JJW, Venn RRM. Perioperative fluid volume optimization following proximal femoral fracture. Cochrane Database of Systematic Reviews 2004, Issue 1. CD003004.
    1. Sinclair S, James S, Singer M. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. British Medical Journal 1997; 315: 909-12.
    1. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. British Journal of Anaesthesia 2009; 102: 12-22.
    1. Björkelund KB, Hommel A, Thorngren KG, Gustafson L, Larsson S, Lundberg D. Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study. Acta Anaesthesiologica Scandinavica 2010; 54: 678-88.
    1. Duncan DG, Beck SJ, Hood K, Johansen A. Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward. Age and Aging 2006; 35: 148-53.
    1. Foss NB, Jensen PS, Kehlet H. Risk factors for insufficient perioperative oral nutrition after hip fracture surgery within a multi-modal rehabilitation programme. Age and Aging 2007; 36: 538-43.
    1. Foss N, Kehlet H. Mortality analysis in hip fracture patients: implications for design of future outcome trials. British Journal of Anaesthesia 2005; 94: 24-9.
    1. The Hip Fracture Perioperative Network. (accessed 30/08/2011).
    1. The National Hip Fracture database. (accessed 30/08/2011).
    1. General Medical Council. Consent: patients and doctors making decisions together. June, 2008. (accessed 30/08/2011).
    1. Association of Anaesthetists of Great Britain and Ireland. Consent for anaesthesia. 2nd ed. January 2006. (accessed 30/08/2011).
    1. Royal College of Anaesthetists. Curriculum for a CCT in Anaesthetics. 2 ed. August, 2010. (accessed 30/08/2011).
    1. Wiles MD, Moran CG, Sahota O, Moppett IK. Nottingham Hip Fracture Score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur. British Journal of Anaesthesia 2011; 106: 501-4.

Source: PubMed

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