Hip fracture. Surgical decisions that affect medical management.

Primary care physicians can provide optimal care for their older patients with hip fracture when they are familiar with the repair techniques used by the orthopedic surgeon. For medically stable patients, surgical repair is now recommended 24 to 72 hours after the fracture. The type of surgery depends on the type of fracture and the degree of the patient's prefracture mobility; options range from simple percutaneous pinning to total hip replacement. Surgery is not advisable for bed-ridden or moribund patients, nor for those with very osteoporotic bones and extensively comminuted fractures. Complications of a hip fracture and its surgical repair that require medical management include anemia, phlebitis, pulmonary embolism, decubitus ulcer, fluid or electrolyte imbalance, and pneumonia.