Skip to main content
    • Aa
    • Aa

Improving hip fracture care: striving for excellence

  • N Nandi (a1), M Maddula (a1) and O Sahota (a1)

Hip fracture is a common and potentially devastating injury that occurs mainly in older people. The incidence is predicted to rise by 30% in the next 10 years alone. Many of those who recover suffer a loss of mobility and independence. There is growing emphasis to improve the care of patients sustaining hip fracture, especially in those with concurrent cognitive impairment. This review focuses on current best practice as well as several key areas of management, including analgesia, anaemia and nutrition. In doing so, we hope to identify interventions that may form the basis of a future Enhanced Recovery Pathway dedicated to hip fracture care.

Corresponding author
Address for correspondence: Professor Opinder Sahota, Health Care for the Older Person, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH. Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

4 JJW Roche , RT Wenn , O Sahota , CG Moran . Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: postoperative observational cohort study. BMJ 2005; 331: 1374.

5 J Magaziner , L Fredman , W Hawkes et al.Changes in functional status attributable to hip fracture (a comparison of hip fracture patients to community-dwelling aged). Am J Epidemiol 2003; 157: 1023–31.

6 M Bertram , R Norman , L Kemp , T Vos . Review of the long-term disability associated with hip fractures. Inj Prev 2011; 17: 365–70.

9 O Ljungqvist . ERAS – Enhanced Recovery After Surgery. J Visceral Surg 2011; 148: e15759.

18 C Kammerlander , T Roth , SM Friedman et al.Ortho-geriatric service – a literature review comparing different models. Osteoporos Int 2010; 21 (suppl 4): s63746.

19 G Pioli , A Giusti , A Barone et al.Orthogeriatric care for the elderly with hip fractures: where are we? Aging Clin Exp Res 2008; 20: 113–22.

22 EN De Vries , HA Prins , RMPH Crolla et al.Effect of a comprehensive surgical safety system on patient outcomes. New Engl J Med 2010; 363: 1928–37.

25 H Kehlet , DW Wilmore . Fast-track surgery. Br J Surg 2005; 92: 34.

26 K Varadhan , KR Neal , CHC Dejong et al.The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: A meta-analysis of randomized controlled trials. Clinical Nutrition 2010; 29: 434–40.

27 MJ Parker , GA Pryor , J Myles . 11-year results in 2,846 patients of the Peterborough Hip Fracture Project: reduced morbidity, mortality and hospital stay. Acta Orthop Scand 2000; 71: 3438.

29 O Sahota , N Morgan , CG Moran . The direct cost of acute hip fracture care in care home residents in the UK. Osteoporosis Int 2012; 23: 917–20.

30 F Leung , TW Lau , K Kwan et al.Does timing of surgery matter in fragility hip fractures? Osteoporos Int 2010; 21 (suppl 4): s52934.

31 P Cuvillon , J Ripart , S Debureaux , C Boisson , E Veyrat , A Mahamat et al.[Analgesia after hip fracture repair in elderly patients: the effect of a continuous femoral nerve block: a prospective and randomised study]. Ann Fr Anesth Reanim 2007; 26: 29.

32 B Fischer , C Simanski , on behalf of the PROSPECT Working Group. A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia 2005; 60: 1189–202.

33 HB Fischer , CJ Simanski , C Sharp , F Bonnet , F Camu , EA Neugebauer , N Rawal , GP Joshi , SA Schug , H Kehlet . A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 2008; 63: 1105–23.

34 FJ Singelyn , M Deyaert , D Joris , E Pendeville , JM Gouverneur . Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesthesia Analgesia 1998; 87: 8892.

38 P Marhofer , K Schrogendorfer , H Koinig , S Kapral , C Weinstabl , N Mayer . Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg 1997; 85: 854–57.

39 NB Foss , MT Kristensen , BB Kristensen et al.Effect of post-operative analgesia on rehabilitation and pain after hip fracture surgery. Anaes 2005; 102: 1197–204.

40 EA Halm , JW Wang , K Boockvar . The effect of perioperative anaemia on clinical and functional outcomes in patients with hip fracture. J Orthop Trauma 2004; 18: 369–74.

41 VA Lawrence , JH Silverstein , JE Cornell et al.Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion 2003; 43: 1717–22.

42 JL Carson , ML Terrin , H Noveck et al.Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011; 365: 2453–62.

43 JL Carson , A Duff , JA Berlin et al.Perioperative blood transfusion and postoperative mortality. JAMA 1998; 279: 199205.

44 C Madjdpour , DR Spahn . Allogeneic red blood cell transfusions: efficacy, risks, alternatives and indications. Br J Anaesthesia 2005; 95: 3342.

45 T Koren-Hakim , A Weiss , A Hershkovitz et al.The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity and outcome. Clinical Nutrition 2012; doi:10.1016/j.clnu.2012.03.010.

46 KA Yuill , RA Richardson , Davidson et al.The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively – a randomised clinical trial. Clinical Nutrition 2005; 24: 3237.

47 O Ljungqvist , J Nygren , A Thorell et al.Preoperative nutrition – elective surgery in the fed or the overnight fasted state. Clinical Nutrition 2001; 20 (suppl 1): 167–71.

48 SE Noblett , DS Watson , H Huong et al.Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis 2006; 8: 563–69.

50 DP Seitz , N Adunuri , SS Gill , PA Rochan . Prevalence of dementia and cognitive impairment among older adults with hip fractures. J Am Med Dir Assoc 2011; 12: 556–64.

52 JN Laditka , SB Laditka , CB Cornman . Evaluating hospital care for individuals with Alzheimer's disease using inpatient quality indicators. Am J Alzheimers Dis Other Demen 2005; 20: 2736.

53 NL Baker , MN Cook , HM Arrighi , R Bullock . Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988–2007. Age Ageing 2011; 40: 4954.

54 SE Bentler , L Liu , M Obrizan et al.The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009; 170: 1290–99.

55 M Cree , KC Carriere , CL Soskolne , M Suarez-Almazor . Functional dependence after hip fracture. Am J Phys Med Rehabil 2001; 80: 736–43.

56 GB Aharonoff , A Barsky , R Hiebert et al.Predictors of discharge to a skilled nursing facility following hip fracture in New York State. Gerontology 2004; 50: 298302.

58 EJ Lenze , MC Munin , MA Dew et al.Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. Int J Geriatr Psychiatry 2004; 19: 472–78.

59 B Samuelson , MI Hedstrom , S Ponzer et al.Gender differences and cognitive aspects on functional outcome after hip fracture – a 2 years follow up of 2,134 patients. Age Ageing 2009; 38: 686–92.

60 S Mitani , M Shimizu , M Abo , H Hagino , Y Kurozawa . Risk factors for second hip fractures among elderly patients. J Orthop Sci 2010; 15: 192–97.

61 KS McGilton , A Davis , N Mahomed et al.An inpatient rehabilitation model of care targeting patients with cognitive impairment. BMC Geriatr 2012; 12: 21. doi: 10.1186/1471-2318-12-21.

63 RS Morrison , J Magaziner , M Gilbert et al.Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol 2003; 58: 7681.

68 FC Goldstein , DC Strasser , JL Woodard et al.Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. J Am Geriatr Soc. 1997; 45: 3542.

70 SW Muir , AM Yohannes . The impact of cognitive impairment on rehabilitation outcomes in elderly patients admitted with a femoral neck fracture: a systematic review. J Geriatr Phys Ther 2009; 32: 2432.

71 TM Huusko , A Karppi , V Avikainen et al.Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ 2000; 321: 1107–11.

72 M Stenvall , B Olofsson , L Nyberg et al.Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomised controlled trial with 1-year follow-up. J Rehabil Med 2007; 39: 232–38.

74 S Morghen , S Gentile , E Ricci et al.Rehabilitation of older adults with hip fracture: cognitive function and walking abilities. JAGS 2011; 59: 1497–502.

75 I Saltvedt , A Prestmo , E Einarsen et al.Development and delivery of patient treatment in the Trondheim Hip Fracture Trial. A new geriatric in-hospital pathway for elderly patients with hip fracture. BMC Res Notes 2012; 5: 355.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Reviews in Clinical Gerontology
  • ISSN: 0959-2598
  • EISSN: 1469-9036
  • URL: /core/journals/reviews-in-clinical-gerontology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 2
Total number of PDF views: 13 *
Loading metrics...

Abstract views

Total abstract views: 215 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 27th May 2017. This data will be updated every 24 hours.