Established practice is to operate on hip fracture patients promptly once they are medically optimised, usually within a day or two of admission, and to involve orthogeriatric care. Delay is linked to worse outcomes.
Delirium is common and often missed. Screen for it daily, correct pain, dehydration, constipation, urinary retention and sensory deprivation, and review sedatives and anticholinergic drugs.
- Aim for early surgery once fluid status and comorbidities are optimised.
- Screen for delirium daily with a validated tool.
- Treat pain adequately, but avoid unnecessary sedatives and anticholinergics.
- Check for urinary retention and constipation.
Why it matters
Most of the preventable harm after hip fracture comes from delay and unrecognised delirium, not from the choice of block.
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