Most<unk> s are treated surgically by implanting a prosthesis. Surgical treatment outweighs the risks of nonsurgical treatment which requires extensive bedrest. Prolonged immobilization increases risk of thromboembolism, pneumonia, deconditioning, and decubitus ulcers. Regardless, the surgery is a major stress, particularly in the elderly. Pain is also significant, and can also result in immobilization, so patients are encouraged to become mobile as soon as possible, often with the assistance of physical therapy. Skeletal traction pending surgery is not supported by the evidence. Regional nerve blocks are useful for pain management in<unk> s. Peripheral nerve blocks may reduce pain on movement and acute confusional state, may improve time to first mobilisation, and may reduce the risk of postoperative lower respiratory tract infection. Surgery can be performed under general anaesthesia or with neuraxial techniques – choice is based on surgical and patient factors, as outcomes such as mortality and post-procedure complications including pneumonia, MI, stroke or confusion, are not affected by anaesthetic technique. Red blood cell transfusion is common for people undergoing<unk>  surgery due to the blood loss sustained during surgery and from the injury. The benefits of giving blood when the hemoglobin is less than 10 g/dL versus less than 8 g/dL are not clear. Waiting until the hemoglobin was less than 8 g/dL or the person had symptoms may increase the risk of heart problems. If operative treatment is refused or the risks of surgery are considered to be too high the main emphasis of treatment is on pain relief. Skeletal traction may be considered for long-term treatment. Aggressive chest physiotherapy is needed to reduce the risk of pneumonia and skilled rehabilitation and nursing to avoid pressure sores and DVT/pulmonary embolism Most people will be bedbound for several months. Non-operative treatment is now limited to only the most medically unstable or demented patients or those who are nonambulatory at baseline with minimal pain during transfers. Surgery on the same day or day following the break is estimated to reduce postoperative mortality in people who are medically stable. Intracapsular fractures Fracture treated with cannulated screws For low-grade fractures (Garden types 1 and 2), standard treatment is fixation of the fracture in situ with screws or a sliding screw/plate device. This treatment can also be offered for displaced fractures after the fracture has been reduced. Fractures managed by closed reduction can possibly be treated by percutaneously inserted screws. In elderly patients with displaced or intracapsular fractures many surgeons prefer to undertake a hemiarthroplasty, replacing the broken part of the bone with a metal implant. However, in elderly people who are medically well and still active, a total<unk>  replacement may be indicated. Independently mobile older adults with<unk> s may benefit from a total<unk>  replacement instead of hemiarthroplasty. Traction is contraindicated in femoral neck fractures due to it affecting blood flow to the head of the femur. The latest evidence suggests that there may be little or no difference between screws and fixed angle plates as internal fixation implants for intracapsular<unk> s in older adults. The findings are based on low quality evidence that can't firmly conclude major difference in<unk>  function, quality of life, and additional surgery. Trochanteric fracture Fracture supported by dynamic<unk>  screw A trochanteric fracture, below the neck of the femur, has a good chance of healing. Closed reduction may not be satisfactory and open reduction then becomes necessary. The use of open reduction has been reported as 8-13% among pertrochanteric fractures, and 52% among intertrochanteric fractures. Both intertrochanteric and pertrochanteric fractures may be treated by a dynamic<unk>  screw and plate, or an intramedullary rod. The fracture typically takes 3–6 months to heal. As it is only common in elderly, removal of the dynamic<unk>  screw is usually not recommended to avoid unnecessary risk of second operation and the increased risk of re-fracture after implant removal. The most common cause for<unk> s in the elderly is osteoporosis; if this is the case, treatment of the osteoporosis can well reduce the risk of further fracture. Only young patients tend to consider having it removed; the implant may function as a stress riser, increasing the risk of a break if another accident occurs. Subtrochanteric fractures Subtrochanteric fractures may be treated with an intramedullary nail or a screw-plate construction and may require traction pre-operatively, though this practice is uncommon. It is unclear if any specific type of nail results in different outcomes than any other type of nail. A lateral incision over the trochanter is made and a cerclage wire is placed around the fracture for reduction. Once reduction has been achieved a guide canal for the nail is made through the proximal cortex and medullary. The nail is inserted through the canal and is fixated proximally and distally with screws. X-rays are obtained to ensure proper reduction and placement of the nail and screws are achieved. Rehabilitation Rehabilitation has been proven to increase daily functional status. Forty percent of individuals with<unk> s are also diagnosed with dementia or mild cognitive impairment which often results in poorer post-surgical outcomes. In such cases enhanced rehabilitation and care models have been shown to have limited positive effects in reducing delirium and hospital length of stay. It is unclear if the use of anabolic steroids effects recovery. There is not enough evidence to ascertain what are the best strategies to promote walking after<unk>  surgery. On the other hand, there is moderate-certaintly evidence that rehabilitation after<unk>  surgery, when delivered by a multidisciplinary team and supervised by an appropriate medical specialist, results in fewer cases of 'poor outcome', like death and deterioration in residential status. Nutrition supplementation Oral supplements with non-protein energy, protein, vitamins and minerals started before or early after surgery may prevent complications during the first year after<unk>  in aged adults; without seemingly effects on mortality. Surgical complications Deep or superficial wound infection has an approximate incidence of 2%. It is a serious problem as superficial infection may lead to deep infection. This may cause infection of the healing bone and contamination of the implants. It is difficult to eliminate infection in the presence of metal foreign bodies such as implants. Bacteria inside the implants are inaccessible to the body's defence system and to antibiotics. The management is to attempt to suppress the infection with drainage and antibiotics until the bone is healed. Then the implant should be removed, following which the infection may clear up. Implant failure may occur; the metal screws and plate can break, back out, or cut out superiorly and enter the joint. This occurs either through inaccurate implant placement or if the fixation does not hold in weak and brittle bone. In the event of failure, the surgery may be redone or changed to a total<unk>  replacement. Mal-positioning: The fracture can be fixed and subsequently heal in an incorrect position; especially rotation. This may not be a severe problem or may require subsequent osteotomy surgery for correction.
Hip fracture
Osteoarthritis
Bosworth fracture
Greater trochanteric pain syndrome
Hume fracture
Hernia
Holdsworth fracture
Avascular necrosis