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Hip fracture...Part 2...Why operate immediatly?



Many experts advocate repairing hip fractures expeditiously—within 8 to 24 hours from admission to the hospital.

In published series, patients who underwent surgery earlier had lower rates of nonunion, avascular necrosis of the femoral head, urinary tract infections, decubitus ulcers, pneumonia, venous thromboembolism,and death,and better long-term functional status than did those who underwent surgery later.

In addition, delaying surgery prolongs the patient's pain and suffering.
In a recent prospective cohort study of 1,206 patients, those who underwent surgery within 24 hours had significantly fewer days of severe and very severe pain and shorter lengths of hospital stay.
Higher pain ratings in patients with hip fracture are associated with longer postoperative lengths of stay, delayed postoperative rehabilitation, and increased risk of delirium, which increases mortality and complications in elderly hospitalized patients.

However, the evidence in this area is flawed by the heterogeneity and retrospective design of the studies.
To date, no randomized prospective study has compared delayed surgery with expeditious surgery, so it is difficult to know whether surgical delay adversely affects outcomes directly, or whether delay in surgery is simply a reflection of underlying morbidities that adversely affect outcomes.

Perez JV, Warwick DJ, Case CP, Bannister GC. Death after proximal femoral fracture-an autopsy study. Injury 1995; 26:237-240.

Villar RN, Allen SM, Barnes SJ. Hip fractures in healthy patients: operative delay versus prognosis. Br Med J (Clin Res Ed) 1986; 293:1203-1204.

Rogers FB, Shackford SR, Keller MS. Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls. J Trauma 1995; 39:261-265.

Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA 2004; 291:1738-1743.

Morrison RS, Magaziner J, McLaughlin MA, et al. The impact of postoperative pain on outcomes following hip fracture. Pain 2003;103:303-311.
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