Does timing of surgery matter in fragility hip fractures?

Osteoporos Int (2010) 21 (Suppl 4):S529S534 DOI 10.1007/s00198-010-1391-2

REVIEW

Does timing of surgery matter in fragility hip fractures?

F. Leung & T. W. Lau & K. Kwan & S. P. Chow &

A. W. C. Kung

Received: 18 August 2010 /Accepted: 31 August 2010# The Author(s) 2010. This article is published with open access at Springerlink.com

Abstract The effect of delay of surgery on the geriatric hip fractures has been a subject of interest in the past two decades. While the elderly patients will not tolerate long periods of immobilization, it is still unclear how soon these surgeries need to be performed. A review of existing literature was performed to examine the effect of timing of surgery on the different outcome parameters of these patients. Although there is conflicting evidence that early surgery would improve mortality, there is widespread evidence in the literature that other outcomes including morbidity, the incidence of pressure sores, and the length of hospital stay could be improved by shortening the waiting time of hip fracture surgery. We concluded that it is beneficial to the elderly patients to receive surgical treatment as an urgent procedure as soon as the body meets the basic anesthetic requirements.

Keywords Complication . Hip fracture . Mortality.

Outcome . Timing of surgery

Introduction

Fragility hip fracture is a major cause of mortality and morbidity in the elderly. The primary goal of treatment for these fractures is to achieve stable and painless lower

extremity as soon as possible. The optimal treatment for these injuries is surgery since non-operative treatment was associated with longer hospitalization, more mal-unions, and less likely to return to an independent level of functioning [1]. It is then logical to perform early surgery for medically stable patients since prolonged immobilization is likely to increase the chance of pulmonary and urinary complications. However, for patients with significant co-morbidities, a longer period of pre-operative evaluation and optimization will be required.

The effect of timing of surgery on patients undergoing hip fracture surgery has been a subject of interest in the past two decades. The evidences examining the timing and outcome in hip fracture surgery have been largely prospective or retrospective cohort studies. This is due to the fact that the design of randomized controlled trials regarding...