Medical Management of Common Comorbidities in Elderly Patients with Proximal Femur Fractures

Abstract

Objectives: Provide a framework for the medical treatment of patients with proximal femur fractures. Design: Literature review and evidence based note template. Intervention: Medical management of patient undergoing operative fixation of proximal femur fracture. Main outcome measurement: Perioperative morbidity. Results and conclusions: Proximal femur fractures are common orthopaedic injuries in the geriatric population and present with morbidity and portend mortality. The current evidence suggests that most patients should be surgically managed 24-48 hours from injury in accordance with patient preferences and medical risk stratification. Doing so is likely to improve postoperative outcomes and save both patients and hospital systems financial resources. After proper history and physical examination, imaging with plain radiographs is recommended, with MRI indicated in occult fractures. There are numerous cardiovascular, cognitive, and endocrinologic comorbidities that may delay or impact surgical treatment of hip fracture patients. This review discusses informed consent, cardiovascular implantable electronic devices, anticoagulation, preoperative cardiovascular evaluation, anemia, congenital heart disease, cerebrovascular accident, hyponatremia, diabetes mellitus, end-stage renal disease, osteoporosis, COVID-19 and chronic obstructive pulmonary disease, and history of bariatric surgery. A proper understanding of how these conditions affect hip fracture patients may help orthopaedic surgeons to expedite surgery safely and effectively and may also serve as a framework in the management of other fragility fractures in patients with comorbidities. Level of Evidence: IV, systematic review Keywords: Hip Fracture, Medical co-management, Geriatrics, Fragility fracture, Osteoporosis, Comorbidity, Comorbidity management, Anesthesia, Perioperative morbidity, Cardiovascular, Cerebrovascular, Renal disease, Surgical timing. (J Ortho Business 2022; Volume 2, Issue 2