Hip fracture is a huge problem among the elderly population. It is estimated that more than 300,000 patient are being hospitalized each year for hip fracture in the US alone. The medical cost of hip fractures exceeds 8 billion annually.

Elderly patients are particularly prone to this injury for two reasons. Elderly people fall more often due to an impaired balance and medications effect. Osteoporosis is also more prevalent among the elderly.

Medical management of the elderly patient with a hip fracture is often challenging.

89 year old male with multiple medical problems including coronary artery disease, congestive heart failure, hypertension, atrial fibrillation and chronic kidney insufficiency presented with a comminuted femur fracture (click on the image above). The patient sustained a fall from a ladder. This patient also was taking Coumadin (Warfarin) with an elevated PT/INR.

The orthopedic surgeon recommended surgery to fix the fracture. The patient was given Vitamin K and FFP (fresh frozen plasma) to reverse his coagulopathy. Diuretics were given to prevent volume overload and decompensation of his congestive heart failure.

Despite aggressive medical management the patient developed progressive renal failure and CHF. This would tremendously increase his peri-operative risk.

Now, here is the dilemma. This patient is at increased risk for surgery and can die on the operating table or shortly thereafter. On the other hand, if the hip is not fixed, the patient will unlikely be able to survive beyond several months. Bedridden elderly patients often succumb to pneumonia and other infections.

As the population is getting older, more and more elderly patients are being admitted with a hip fracture. The decision of taking the risk of surgery or letting the patient be should be made on an individual basis. The patient’s and the family’s preference should, obviously, be taken into the account. Very often, though, we are asked to decide if we should take a huge risk of the surgery or let the patient die slowly from being bedridden. There is never a perfect answer to this question.