Phys · geriatric
Orthogeriatrics and Perioperative Medicine in Older Adults
Also known as Orthogeriatrics and Perioperative Medicine in Older Adults · orthogeriatrics and perioperative medicine in older adults
Consultant-physician depth guide to orthogeriatric hip-fracture care for FRACP DWE/DCE — the 36-to-48-hour rule, apixaban timing, restrictive transfusion, delirium prevention, Garden-based implant choice and denosumab-exit secondary prevention. Structured for FRACP DWE/DCE, MRCP and ABIM preparation.
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Red flags
- Optimising a hip-fracture patient into day three or four raises mortality — deliver targeted optimisation and operate within 36 to 48 hours
- A displaced Garden III or IV femoral neck fracture needs arthroplasty, not screws — fixation risks avascular necrosis through the retinacular vessels
- Stopping denosumab without a bisphosphonate follow-on triggers rebound vertebral fractures — plan the exit before starting the drug
- Transfuse restrictively at 70 to 80 g/L (80 to 100 with cardiac disease) — liberal transfusion adds volume overload without benefit
- Using recalled thresholds without a cited source is forbidden — verify before acting
Meet the patient
Mr F is an 86-year-old man with hypertension, paroxysmal atrial fibrillation on apixaban, type 2 diabetes, and mild cognitive impairment, who tripped on a rug at home and cannot weight-bear. His X-ray shows a displaced right femoral neck fracture, he is confused, and his eGFR is 35. The registrar wants to "optimise him" before theatre. The question that decides whether he survives the year is not which implant — it is whether you operate within 48 hours, reverse the apixaban safely, prevent delirium, and start the bone-protection that stops the next fracture.[1][11]
Hold those four levers — time to surgery, anticoagulation, delirium, bone protection — and the whole topic falls into place.[5]
References8ShowHide
- [1]Xu X, Wang Z, Zhao C, Fan H, et al. Perioperative Anemia and Transfusion Management in Older Adults with Osteoporotic Hip Fractures: A Narrative Review of Current Evidence and Emerging Strategies Clin Interv Aging, 2026.PMID 42445619
- [2]Rao H, Luo L, Cheng J, Wu G, et al. Management of hip fracture in older adults with cognitive impairment: a narrative review Front Public Health, 2026.PMID 42145490
- [3]Ferrara MC, Remelli F, Trevisan C, Triolo F, et al. Association of pre- and postoperative delirium with functional status at discharge after hip fracture: findings from the Gruppo Italiano di Ortogeriatria (GIOG 2.0) study Eur Geriatr Med, 2026.PMID 41824264
- [4]Smolka V, Olotu C, Modreker M, Drebenstedt C, et al. Pain management in the perioperative orthogeriatric setting: Recommendations of the special interest group Orthogeriatrics of the German Geriatrics Society Z Gerontol Geriatr, 2026.PMID 41706125
- [5]Sacks B, Mughal HN, Ahluwalia A, Rudran B, et al. The BOAST recommendations for care of the older or frail orthopaedic trauma patient Br J Hosp Med (Lond), 2020.PMID 32730158
- [6]Lems WF, Dreinhöfer KE, Bischoff-Ferrari H, Blauth M, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures Ann Rheum Dis, 2017.PMID 28007756
- [10]Holness TJO, Haque S, Harris BHL, Fertleman MB, et al. Orthogeriatric care after hip fracture: the role of process reliability in improving outcomes J Orthop Surg Res, 2026.PMID 42343316
- [11]Lin CC, Qureshi I, Richardson MA, Anil U, et al. Demographics, disparities and delays: why can't geriatric hip fractures get fixed within one day? Orthop Traumatol Surg Res, 2026.PMID 42092689