The American Academy of Orthopaedic Surgeons has released new appropriate use criteria for the treatment and rehabilitation of hip fractures for patients 60 years of age and older.
“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,” Robert Quinn, MD, appropriate use criteria section leader for the American Academy of Orthopaedic Surgeons (AAOS) Committee on Evidence-based Quality and Value, said in an AAOS press release. “We are providing evidence-based assistance for physicians and patients to determine the best course of action for surgery and follow-up care.”
“Appropriate Use Criteria for the Treatment of Hip Fractures in the Elderly” are based upon the activity levels, bone and joint health, fracture locations, stability of the break and other patient-specific factors. Total hip replacement, for example, is deemed appropriate for highly active patient with a non-displaced fracture in the femoral neck, but is classified as rarely appropriate for non-ambulatory patients. According to the release, multiple appropriate treatments may appear in some cases due to a lack of consensus from the review panel on the single best course of action due to surgeons’ preferences and multiple correct treatments for surgery.
“Perioperative Prevention of Future Fractures Checklist,” a 12-point preoperative checklist, accompanied the guidelines to assist in the delivery of quality care. Items include limiting preoperative traction, management of warfarin and discussion of the patient's home environment prior to discharge.
A second appropriate use criteria “Appropriate Use Criteria for Postoperative Rehabilitation for Low Energy Hip Fractures in the Elderly” provides universal recommendations for recovery across elderly populations. Recommendations include the prevention of deep vein thrombosis via interdisciplinary care; prevention and management of postoperative delirium; multimodal perioperative pain management, interdisciplinary management of recovery at rehabilitation and skilled nursing facilities; home care therapy after discharge; and osteoporosis assessment and management. A checklist also accompanied the recovery guidelines. Points of emphasis noted within were participation in a fall prevention program and supplements/medications to improve bone density.
“It is important to think ahead to make the right care choices after a fracture is repaired,” Quinn said. “Not only can this help patients recover, but this also helps prevent fractures from happening again, which is a big problem.”