Wednesday, February 22, 2006

Best practices in hip fracture care

Hospitalists are often involved in the co management of patients with hip fracture. Published in the November issue of the Journal of General Internal Medicine, (linked via Medscape) this systematic review looked at multiple practices in the perioperative care of hip fracture patients. Specialty mattresses to prevent pressure ulcers, regional anesthesia, DVT prophylaxis, antibiotic prophylaxis, replacing continuous urinary catheters with intermittent catheterization, and epidural analgesia are supported by high level studies. Performance of surgery within 24 hours is also associated with better outcomes although there are no level 1 studies.

Somewhat surprisingly, several popular interventions are not supported by evidence. These include traction, postoperative drains and the use of multidisciplinary teams.

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