Hip Fracture

A complete history and physical examination with specific concern for any anaesthetic risk is required prior to surgery. Previous infections about the hip or history of venous thromboembolism (blood clots) should be specifically applicable to hip surgery. A careful review of current medication is also necessary. Specific emphasis on the history of malignancies to help rule out occult pathologic fractures is required. In addition, careful note should be made of the patient's cognitive and functional status prior to surgery. This information is helpful in making prognosis for recovery after surgery and for assessing the need for postoperative rehabilitation. Cross matching of blood is necessary, as transfusion frequently will be required perioperatively.

Unnecessary delay of a patient's operative intervention appears to worsen the outcome. Ideally, elderly patients should undergo surgery within the first forty-eight hours of injury, as delay beyond this appears to decrease their overall recovery. As these patients often have significant medical problems, the focus should be on correcting any reversible medical condition within twenty-four to forty-eight hours. Similarly, because of the periods of fasting (once admitted into hospital, patients are not permitted to eat or drink prior to surgery. If there are delays prior to surgery this might prolong the period of fast or there may be multiple fasts depending on delays), care must be taken to optimize the patient's nutrition and hydration prior to surgery.

Hip fractures are often clinically obvious, but other causes of groin pain and leg deformity need to be considered, including fractures of the pubic rami, lumbar spine disease, trochanteric bursitis, osteoarthritis or inflammatory arthritis of the hip, or, rarely, a septic hip joint.