Rehabilitation for Elderly Patients with Hip Fractures
The American Academy of Orthopaedic Surgeons (AAOS) Board of Directors recently approved Appropriate Use Criteria (AUC) for treatment and rehabilitation of elderly patients with hip fractures, in addition to postoperative direction to help prevent fractures from recurring.
A releasr from AAOS notes that hip fractures, common in older adults, often occur due to falls or slips because bones are fragile.
The release quotes Robert Quinn, MD, AUC Section Leader for the AAOS Committee on Evidence-Based Quality and Value, as saying, “Hip fractures are one of the most feared injuries in older adults because this trauma creates pain and can force a change in lifestyle or limited mobility. We are providing evidence-based assistance for physicians and patients to determine the best course of action for surgery and follow-up care.”
Pinning bones back together using surgical screws versus reconstructing the hip joint through total hip replacement (THR) surgery has long been debated. The AUC criteria rely on peer-reviewed studies and practices to recommend different procedures depending on a patient’s individual indications such as activity levels, bone and joint health, location(s) of the fracture, and whether the break is stable or displaced. The AUC addresses patients age 60 and above with fractures caused by low-impact events.
The AUC panel included physicians and physical therapists from leading academic medical centers, in addition to orthopaedic and other professional medical societies, who reviewed 30 potential patient scenarios to create the “Appropriate Use Criteria for the Treatment of Hip Fractures in the Elderly.” Each treatment in each patient scenario is rated “appropriate,” “may be appropriate,” and “rarely appropriate.”
For example, THR is rated “appropriate” for a highly active patient with a non-displaced fracture in the neck of the femur bone. However, the same procedure is “rarely appropriate” for a non-ambulatory patient.
Another example rates reattaching bone with a specific type of screw (sliding hip anti-rotation screws) as “appropriate” for highly active patients with and without arthritis who have a stable fracture of the intertrochanteric crest, located near the top of the femur.
Dr. Quinn added that in some cases, the AUC review panel did not reach consensus on a single best course of action due to surgeons’ preferences and multiple correct treatments for surgery.
Accompanying the AUC, the AAOS created a “Preoperative Checklist” to assist surgeons and allied medical providers in delivering quality care to patients by completing 12 important initiatives. They include limiting preoperative traction; managing Warfarin, a blood-thinning medication; and discussing the patient’s home environment prior to discharge.
Hip fracture recovery guidelines