Hip fracture

Abstract

INTRODUCTION: Between 12% and 37% of people will die in the year after a hip fracture, and 10-20% of survivors will move into a more dependent residence. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of surgical interventions in people with hip fracture? What are the effects of perisurgical medical interventions on surgical outcome and prevention of complications in people with hip fracture? What are the effects of rehabilitation interventions and programmes after hip fracture? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 52 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: anaesthesia (general, regional), antibiotic regimens, arthroplasty, choice of implant for internal fixation, conservative treatment, coordinated multidisciplinary approaches for inpatient rehabilitation of older people, cyclical compression of the foot or calf, early supported discharge followed by home-based rehabilitation, extramedullary devices, fixation (external, internal), graduated elastic compression, intramedullary devices, mobilisation strategies, nerve blocks for pain control, nutritional supplementation (oral multinutrient feeds, nasogastric feeds), perioperative prophylaxis with antibiotics, antiplatelet agents, or heparin (low molecular weight or unfractionated), preoperative traction to the injured limb, surgery, and systematic multicomponent home-based rehabilitation.