title: [Procedural organisation: surgical and anaesthesiological management in hip fractures].
abstract: In patients with hip fractures, in order to reduce the high number of general complications and those associated with the specific treatment, the functional loss and cognitive impairment, implementation of co-ordinated, multidisciplinary treatment pathways, and rehabilitation, is mandatory. The imminent treatment of proximal femoral fracture consists of major orthopaedic surgery in most cases (total or partial hip arthroplasty, osteosynthesis). After the diagnosis of a hip fracture, an adequate pain medication should be initiated. The decision making for the fracture treatment includes fracture type, patient's age, cognitive function, mobility before the fall and functional demands of the patient in the context of patients life expectancy and goals of care. The anaesthesiological evaluation focuses on risk assessment. Medical abnormalities should be optimized within 24 to 48 h, or an increased perioperative risk due to comorbidities has to be accepted. The timing and the course of further preoperative diagnostic examinations and therapeutic interventions should be co-ordinated between the involved medical disciplines. After the operation a structured screening for delirium should be initiated and further evaluation of patient's nutrition, fall-associated medication, living conditions and osteoporosis treatment has to be performed.
authors.affiliation: Abteilung für Unfallchirurgie, LKH Klagenfurt, Klagenfurt, Austria, ernst.mueller@kabeg.at.
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Müller
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Gerstorfer
authors.forename: Peter
authors.initials: P
authors.lastname: Dovjak
authors.forename: Bernhard
authors.initials: B
authors.lastname: Iglseder
authors.forename: Georg
authors.initials: G
authors.lastname: Pinter
authors.forename: Walter
authors.initials: W
authors.lastname: Müller
authors.forename: Katharina
authors.initials: K
authors.lastname: Pils
authors.forename: Peter
authors.initials: P
authors.lastname: Mikosch
authors.forename: Michaela
authors.initials: M
authors.lastname: Zmaritz
authors.forename: Monique
authors.initials: M
authors.lastname: Weissenberger-Leduc
authors.forename: Markus
authors.initials: M
authors.lastname: Gosch
authors.forename: Heinrich W
authors.initials: HW
authors.lastname: Thaler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D001317:Austria; D003299:Cooperative Behavior; D019091:Critical Pathways / Q000458:organization & administration*; D006305:Health Status Indicators; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D033183:Interdisciplinary Communication; D058866:Osteoporotic Fractures / Q000401:mortality / Q000601:surgery*; D010348:Patient Care Team / Q000458:organization & administration*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D015996:Survival Rate