Hip Fracture: The Choice of Surgery

Excerpt

Hip fractures are operated with either prosthesis or various kinds of fracture fixation devices, with the aim of immediate mobilization with full weight-bearing. Challenges are osteoporotic bone, bone vascularity, muscle-attachments, maintaining fracture reduction and slow fracture healing in the often-elderly population and, although reduced in recent years, still 5–20% of patients need a reoperation, mainly depending on the type of fracture and choice of surgery. The extensive literature has created partial treatment consensus: Undisplaced femoral neck fractures seem adequately treated with parallel screws/pins or a sliding hip screw, while the displaced femoral neck fractures should be given a prosthesis in elderly patients. The stable trochanteric fractures are well treated with a sliding hip screw, while intramedullary nails seem superior for the unstable trochanteric and the sub-trochanteric fractures. During the last decades, surgical guidelines have gained ground, along with national surgical quality standards and registries with possible identification of positive and negative outliers—which is expected to further improve the surgical outcome.