Hip fracture

Provide patients and carers with verbal and written information about anaesthetic and surgical choices and likelihood of functional recovery.

• The patient can expect a discussion about the risks and benefits of spinal or general anaesthesia preoperatively.[45]National Institute for Health and Care Excellence. Hip fracture: management. May 2017 [internet publication]. https://www.nice.org.uk/guidance/cg124

• Discuss and document ceilings of care.

• Involve the patient and any family members or carers in these discussions, as appropriate. Consider any advanced directives, lasting powers of attorney, and safeguarding issues.[79]British Orthopaedic Association. BOAST: the care of the older or frail orthopaedic trauma patient. May 2019 [internet publication]. https://www.boa.ac.uk/uploads/assets/04b3091a-5398-4a3c-a01396c8194bfe16/the%20care%20of%20the%20older%20or%20frail%20orthopaedic%20trauma%20patient.pdf

• Explain that follow-up and the process of rehabilitation will be long-term. Physiotherapy and occupational therapy will be required.

• Set reasonable expectations for recovery. Some loss of function is to be expected in most patients.[1]Parker M, Johansen A. Hip fracture. BMJ. 2006 Jul 1;333(7557):27-30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1488757 http://www.ncbi.nlm.nih.gov/pubmed/16809710?tool=bestpractice.com

• Patients may require long-term care or aides for walking.