Extracts from "Clinical Evidence": Hip fracture

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Abstract
Definition Hip fracture is a fracture of the femur above a point 5 cm below the distal part of the lesser trochanter.1 Intracapsular fractures occur proximal to the point at which the hip joint capsule attaches to the femur. Undisplaced fractures include impacted or adduction fractures. Displaced intracapsular fractures may be associated with disruption of the blood supply to the head of the femur. Numerous subdivisions and classification methods exist for these fractures. In the most distal part of the proximal femoral segment (below the lesser trochanter), the term subtrochanteric is used. Extracapsular fractures occur distal to the hip joint capsule. #### Intervention Beneficial: Sliding hip screw device for internal fixation of extracapsular fracture Antibiotic prophylaxis before surgery Mattress on operating tables to prevent pressure sores Likely to be beneficial: Regional anaesthesia for surgery Arthroplasty for displaced intracapsular fracture Postoperative prophylaxis with heparin to reduce venous thromboembolism Postoperative prophylaxis with antiplatelet agents to reduce venous thromboembolism Postoperative prophylactic cyclical compression of the foot or calf to reduce venous thromboembolism Nutritional supplementation after fracture Geriatric hip fracture programmes in acute orthopaedic units Trade off between benefits and harms: Early supported discharge programmes Unknown effectiveness: Arthroplasty for extracapsular hip fracture Nerve blocks for pain control Use of graduated elastic compression to prevent venous thromboembolism Specialised orthopaedic rehabilitation units for elderly people Systematic home based rehabilitation Unlikely to be beneficial: Conservation (non-surgical) treatment of extracapsular fractures Preoperative bed traction to the injured limb Likely to be ineffective or harmful: Intramedullary fixation with cephalocondylic nail for extracapsular fracture (less effective or more harmful than sliding hip screw) Intramedullary fixation with condylocephalic nail for extracapsular fracture Incidence/prevalence Hip fractures may occur at any age but are most common in elderly people. In industrialised societies, the lifetime risk of hip fracture is about 18% in women and …