Principles Of Management
The primary goal of management is to return patients to their prefracture ambulatory status and level of function. Initial treatment is directed toward pain control, and small, frequent doses of analgesics can be utilized. In displaced hip fractures, splinting of the limb is helpful. Simple splinting, such as bunny-boot traction with five pounds, or skin traction can be utilized. In the undisplaced fracture traction is unnecessary, but care must be used when moving the patient. Skin breakdown can occur within hours, and it is therefore important that the patient position is changed frequently. Only in rare instances is nonsurgical management appropriate. Nonsurgical management may be considered for the stable impacted hip fracture when the patient has already walked following the fall and has minimal or no pain with passive range of motion of the hip; minimal pain with active range of motion of the hip; or nearly full range of motion. Radiographs should demonstrate a stable fracture pattern. Nonoperative management can also be considered in the severely debilitated, cognitively impaired, and previously nonambulatory patient who does not appear to be having any significant discomfort.