title: Hip fracture management, before and beyond surgery and medication: a synthesis of the evidence.
abstract: BACKGROUND
  The geriatrician and orthopedic surgeon's roles are well defined in hip fracture management, yet other health-care providers contribute significantly toward care, as well as maximizing rehabilitation potential and decreasing readmissions. We examine evidence concerning pre-hospital care, pain management, multidisciplinary rehabilitation and secondary prevention strategies.
  
  
  METHODS
  Cochrane reviews and randomized controlled trials were identified through PubMed to synthesize current evidence in the role of multidisciplinary management of the patient with a hip fracture from injury to secondary prevention. The well-recognized roles of the geriatrician, anesthetist and orthopedic surgeon were not evaluated for the purpose of this review.
  
  
  RESULTS
  Transport of patients with a hip fracture can be eased through non-pharmaceutical simple, inexpensive techniques. Nerve blockade appears effective and easily administered in the emergency department. In-hospital multidisciplinary rehabilitation programs are effective in both earlier discharge and reducing falls, morbidity and mortality. Fall prevention programs are effective in nursing home patients, but not community dwellers. Osteoporosis prevention is primarily a medical endeavor; however, exercise and education may contribute to increased bone mineral density, compliance and better results of treatment.
  
  
  CONCLUSIONS
  Multidisciplinary medical management of patients with hip fractures is being improved within the hospital environment resulting in earlier discharge with decreased morbidity. There is evidence to show the benefits to patients with hip fractures from peripheral modalities within the hospital; however unless resident in a facility, multidisciplinary management is not clearly of benefit.
authors.affiliation: Department of Orthopaedics and Rehabilitaion, University of Rochester Medical Centre, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA. natasha_omalley@urmc.rochester.edu
authors.forename: Natasha T
authors.initials: NT
authors.lastname: O'Malley
authors.forename: Michael
authors.initials: M
authors.lastname: Blauth
authors.forename: Norbert
authors.initials: N
authors.lastname: Suhm
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Kates
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D006620:Hip Fractures / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D059408:Pain Management; D010348:Patient Care Team