Fracture management
Also known as: fragility fracture · hip fracture
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AAOS Management of Hip Fractures in Older Adults Evidence-based Clinical Practice Guideline
American Academy of Orthopaedic Surgeons (AAOS) · 2022 · 2nd edition (approved December 2021)
The AAOS evidence-based clinical practice guideline on managing hip fractures in adults aged 55 and older, summarised in the Journal of the American Academy of Orthopaedic Surgeons. It addresses surgical and perioperative management decisions based on a systematic review of the published evidence.
EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures
EULAR and European Federation of National Associations of Orthopaedics and Traumatology (EFORT) · 2017 · 2016/2017 recommendations
Joint European recommendations from EULAR and EFORT, published in Annals of the Rheumatic Diseases, on the care of patients over 50 who have sustained a fragility fracture. They address acute and perioperative management and the systematic assessment and treatment needed to reduce the risk of further fractures.
US vs EU key differences
- The two documents answer different questions: the AAOS guideline is a surgical and perioperative guideline for hip fracture (operative timing within 24-48 hours, spinal versus general anaesthesia, arthroplasty over fixation for displaced femoral neck fractures, cemented stems, tranexamic acid), while the European document is a 10-recommendation framework for preventing the next fracture. source
- Populations differ: the AAOS guideline is restricted to older adults with hip fracture, whereas the EULAR/EFORT recommendations apply to any patient over 50 with a recent fragility fracture at any site. source
- The European recommendations are built around a coordinator-led fracture liaison service and multidisciplinary orthogeriatric care, with systematic future-fracture risk assessment and non-pharmacological plus pharmacological treatment for high-risk patients. source
- Version currency differs by roughly five years: the US guideline dates to 2021-2022 and updated over 80% of the evidence-based recommendations in its 2014 predecessor, while the European recommendations date to 2017. source
What changed recently
- US1st edition (2014) → 2nd edition (approved December 2021)2021-12-03
The second edition revised more than 80% of the previous recommendations and widened the covered population from age 65 and older down to 55 and older. It dropped the earlier reservation about the posterior surgical approach for femoral neck fracture, newly favours cemented femoral stems for displaced femoral neck fractures and cephalomedullary devices for unstable intertrochanteric fractures, backs tranexamic acid to cut blood loss, and extends interdisciplinary care from dementia patients to all hip fracture patients.
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