Surgical principles

Surgical principles

Surgical principles

The aims of surgery are to control pain and promote early mobilisation.

British Orthopaedic Association – British Geriatrics Society Blue Book.

Hip fractures

Delay from admission to surgery causes distress for patients and is associated with increased morbidity and mortality. Accordingly, the standard that surgery should be performed on the day of, or the day after, admission to hospital has been set in UK National Institute for Health and Clinical Excellence (NICE) guidelines on hip fracture care. This standard is being echoed in emerging guidelines from several other countries.

Other key priorities for implementation in the NICE guidance include the following points which provide an evidence-based set of principles on hip fracture surgery:

Planning the theatre team

  • Schedule hip fracture surgery on a planned trauma list.

Surgical procedures

  • Perform replacement arthroplasty (hemiarthroplasty or total hip replacement) in patients with a displaced intracapsular fracture.
  • Offer total hip replacements to patients with a displaced intracapsular fracture who:
    – were able to walk independently out of doors with no more than the use of a stick and
    – 
    are not cognitively impaired and
    – 
    are medically fit for anaesthesia and the procedure.
  • Use extramedullary implants such as a sliding hip screw in preference to an intramedullary nail in patients with trochanteric fractures above and including the lesser trochanter (AO classification types A1 and A2).

Cochrane Database Systematic Reviews

The Cochrane group have undertaken several systematic reviews concerned with surgical issues relating to hip fractures including:

Non-hip non-vertebral fractures

Cochrane Database Systematic Reviews

The Cochrane group have undertaken several systematic reviews concerned with surgical issues relating to non-hip non-vertebral fractures:

Additionally, the please visit the journal “Best Practice & Research Clinical Rheumatology”

Vertebral fractures

The American College of Radiology Appropriateness Criteria provides the most recent evidence-based guidance on radiologic imaging of vertebral compression fractures and current indications for vertebral augmentation:

  • ACR Appropriateness Criteria Management of Vertebral Compression Fractures. J Am Coll Radiol. 2014 Jun 14. PubMed ID 24935074

For further information, the please visit the journal “Best Practice & Research Clinical Rheumatology”

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