This 2015 AAOS Clinical Practice Guideline covers the full episode of care for elderly hip fractures. It distills 169 primary studies into 25 graded recommendations — 8 strong, 15 moderate, 2 limited. Topics span ED analgesia, imaging, surgical technique selection, anesthesia, transfusion, rehabilitation, and secondary fracture prevention.
Every elderly patient presenting with hip pain after a fall runs through this guideline whether you realize it or not. When you take a displaced femoral neck fracture to the OR, the decision tree is: arthroplasty (not fixation), cemented stem, anterolateral approach preferred over posterior, and hemi vs THA based on patient activity level and surgeon experience.
For subtrochanteric and reverse obliquity patterns, the answer is a cephalomedullary nail — the sliding hip screw is not appropriate here.
Postoperatively, hold transfusion until hemoglobin drops below 8 g/dL in the asymptomatic patient. Push for OR within 48 hours in medically stable patients, recognizing that those who are delayed for medical reasons already carry the highest mortality regardless of timing.
If plain films are negative but the patient cannot bear weight and clinical suspicion is high, order MRI. A negative CT is not sufficient to rule out occult fracture.
This 2015 AAOS Clinical Practice Guideline covers the full episode of care for elderly hip fractures. It distills 169 primary studies into 25 graded recommendations — 8 strong, 15 moderate, 2 limited. Topics span ED analgesia, imaging, surgical technique selection, anesthesia, transfusion, rehabilitation, and secondary fracture prevention.
Every elderly patient presenting with hip pain after a fall runs through this guideline whether you realize it or not. When you take a displaced femoral neck fracture to the OR, the decision tree is: arthroplasty (not fixation), cemented stem, anterolateral approach preferred over posterior, and hemi vs THA based on patient activity level and surgeon experience.
For subtrochanteric and reverse obliquity patterns, the answer is a cephalomedullary nail — the sliding hip screw is not appropriate here.
Postoperatively, hold transfusion until hemoglobin drops below 8 g/dL in the asymptomatic patient. Push for OR within 48 hours in medically stable patients, recognizing that those who are delayed for medical reasons already carry the highest mortality regardless of timing.
If plain films are negative but the patient cannot bear weight and clinical suspicion is high, order MRI. A negative CT is not sufficient to rule out occult fracture.