Evidence-based guidelines for fixing broken hips: an update.
OBJECTIVE
To update evidence-based guidelines for the treatment of proximal femoral fractures published in the Journal in 1999.


METHODS
Systematic literature search of MEDLINE, CINAHL and EMBASE from January 1996 to September 2001 and the Cochrane Database of Systematic Reviews (most recent issue searched - Issue 2, 2002).


METHODS
Randomised controlled trials and meta-analyses of all aspects of acute-care hospital treatment and rehabilitation of proximal femoral fractures among subjects aged 50 years and over with proximal femoral fractures not associated with metastatic disease or multiple trauma.


METHODS
All studies were read independently by two reviewers. Reviewers recorded individual study results, and an assessment of study quality and treatment conclusions according to Cochrane Collaboration protocols. If necessary, a third review was performed to reach consensus.


RESULTS
93 new studies were identified and 82 met our inclusion criteria. Recommendations for thromboprophylaxis, anaesthesia, surgical fixation of fractures and nutritional status have been altered to incorporate new evidence. Recommendations have been added regarding postoperative blood transfusion, the management of subtrochanteric fractures, and the type of surgical swabs which should be used.


CONCLUSIONS
Although there have been few significant changes to the previous recommendations, updating the guidelines has required substantial effort. The common clinical problem of hip fracture should be treated according to the most up-to-date evidence to achieve the best possible outcomes and optimal utilisation of limited resources. Guideline updates also require resourcing.
Chilov
Michael N
MN
50 Mi Mi Street, Oatley, NSW 2223, Australia. mchilov@gmp.usyd.edu.au
Cameron
Ian D
ID
March
Lyn M
LM
D000925:Anticoagulants / Q000627:therapeutic use; D001803:Blood Transfusion; D019317:Evidence-Based Medicine; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin