Hip Fractures
Anesthesia for Hip Fractures
click for article
NEW EVIDENCE - 2021
Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults
Conclusion: Spinal anesthesia for hip-fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days. The incidence of postoperative delirium was similar with the two types of anesthesia.
Most Common Types of Hip Fractures
Femoral Neck Fracture
Intertrochanteric Fracture
Repair Options
Ch. 9: Hip Fracture - The Choice of Surgery
"The aim of hip fracture surgery is to allow immediate mobilization with full weight-bearing, aiming to achieve the previous level of function, ranging from maintaining normal walking in self-reliant elderly patients to pain relief in chronic bedridden nursing home residents. Three in four patients are expected to live beyond the first post-operative year, so proper surgery is required to alleviate an otherwise long-standing suboptimal functional level. Surgery is technically challenging, with body weight transfer through a broken oblique column, often with reduced bone quality due to osteoporosis—thus the risk of reoperation is high. A poorly operated hip fracture often leads to unequal leg length, pain and irreversible mobility loss, greatly influencing the quality of life."
The High Points
The type of surgery chosen generally depends on where and how severe the fracture is, whether the broken bones are displaced, the patient's age and underlying heath conditions
Hip "pinning" - parallel implants: permit fracture compression through small stab incisions. Limited bleeding, quicker operating time.
IM Nail: Surgery of choice for intertrochanteric fractures
Hemiarthroplasty: replacement of the femoral head only. Fractures to the femoral neck are more likely to disrupt the vascular supply to the head of the femur and necessitate at least a hemiathroplasty
Total hip arthroplasty: provides a better result in an active, independently living, and cognitively intact patient.