Motor-sparing PENG block facilitates early post-block mobilization
VTE prophylaxis evidence
METRC trial (NEJM 2023): aspirin 81 mg non-inferior to enoxaparin for VTE prevention after fracture
No significant difference in DVT, PE, or bleeding events
Aspirin preferred option in some guidelines for lower-risk patients
Duration: minimum 4 weeks recommended regardless of agent
Nutritional supplementation evidence
Oral protein supplementation (>= 1.2 g/kg/day)
Cochrane-level evidence: reduces infective complications by approximately 50%
Reduces pressure ulcers and hospital length of stay
Vitamin D 800-1000 IU/day combined with calcium reduces refracture risk
Patient Discharge Instructions
copy discharge instructions
Understanding your hip fracture surgery
You had an intertrochanteric hip fracture — a break in the upper femur (thigh bone) just below the hip joint
This was repaired with a metal implant (sliding hip screw or nail) that holds the bone while it heals
Bone healing typically takes 3-6 months; the implant remains permanently
Activity instructions
Weight-bearing as tolerated with your walker or crutches as instructed by your physiotherapist
Do not put more weight than advised on the operated leg until your surgeon clears you
Avoid high-impact activities (running, jumping) for at least 3 months
Gentle walking with your walking aid is encouraged from day one after surgery
Hip range-of-motion restrictions: follow your surgeon's specific instructions
Avoid extreme hip flexion, adduction, or internal rotation until advised
Wound care
Keep wound dry until sutures or staples are removed (typically 10-14 days)
Waterproof dressing for showering once advised by your nurse
No submerging in bath, pool, or hot tub until wound fully healed
Pain management at home
Acetaminophen (Tylenol) 500-1000 mg every 6 hours as needed for pain (maximum 4 g/day)
Take with food if it upsets your stomach
Prescribed opioid pain medication: use only as needed for severe pain not controlled by Tylenol
Opioids cause constipation — take stool softener (docusate 100 mg twice daily) while using them
Do not drive or operate heavy machinery while taking opioid medications
Blood clot prevention
Take your prescribed blood thinner (aspirin, enoxaparin, or rivaroxaban) exactly as directed
Blood clot prevention medication is typically required for 4-6 weeks after surgery
Signs of deep vein thrombosis: leg swelling, redness, warmth, or pain in the calf or thigh
Signs of pulmonary embolism: sudden chest pain, shortness of breath, or coughing blood
Both require immediate return to the emergency department
Nutrition and bone health
High-protein diet: aim for at least 1-1.2 grams of protein per kilogram of body weight daily
Good sources: meat, fish, eggs, dairy, legumes, protein supplements
Calcium supplement: 500-600 mg twice daily with meals
Vitamin D supplement: 800-1000 IU daily (or as prescribed)
Fall prevention at home
Home safety: remove loose rugs and clutter; install grab bars in bathroom; ensure good lighting
Consider a shower chair or bench
Review all medications with your family doctor to remove drugs that increase fall risk
Physiotherapy and balance training program is essential for recovery
Return to emergency immediately for
Increasing pain at the wound or hip that is not controlled with medications
Wound drainage (fluid or pus), increasing redness, swelling, or warmth around incision
Fever > 38.3 C (101 F)
Leg swelling, redness, or calf pain (possible blood clot)
Chest pain, shortness of breath, or rapid heart rate
New confusion, severe dizziness, or fainting
References
Guidelines and key sources
Schroeder JD, Turner SP, Buck E. Hip Fractures: Diagnosis and Management. American Family Physician. 2022
Comprehensive primary care and emergency reference for hip fracture diagnosis and management
PMID 36521464
Switzer JA, O'Connor MI. AAOS Management of Hip Fractures in Older Adults Evidence-Based Clinical Practice Guideline. Journal of the American Academy of Orthopaedic Surgeons. 2022
Definitive North American orthopedic guideline for hip fracture management
Covers implant selection, surgical timing, VTE prophylaxis, perioperative care
Bhandari M, Swiontkowski M. Management of Acute Hip Fracture. New England Journal of Medicine. 2017
Classic NEJM clinical practice review covering all aspects of acute hip fracture care
PMID via NEJM: 10.1056/NEJMcp1611090
Liu YT, Tovar Hirashima E, Yadav K. Peripheral Nerve Blocks for Hip Fractures. JAMA. 2025
JAMA evidence review confirming opioid reduction, delirium reduction, and respiratory benefit from nerve blocks
10.1001/jama.2025.0999
METRC, O'Toole RV et al. Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after Fracture. NEJM. 2023
Non-inferiority trial: aspirin 81 mg equivalent to enoxaparin for VTE prevention post-fracture
Informs VTE prophylaxis choice in hip fracture patients
Cochrane reviews
Lewis SR et al. Cephalomedullary Nails Versus Extramedullary Implants for Extracapsular Hip Fractures in Older Adults. Cochrane Database of Systematic Reviews. 2022
Supports CMN for unstable intertrochanteric fracture patterns; SHS equivalent for stable patterns
Viamont-Guerra MR et al. Ultra-Early Versus Early Surgery for Hip Fracture. Cochrane Database of Systematic Reviews. 2024
Emerging evidence supporting surgery within 12 hours for additional benefit
Handoll HH et al. Multidisciplinary Rehabilitation for Older People With Hip Fractures. Cochrane Database of Systematic Reviews. 2021
Evidence base for orthogeriatric co-management and multidisciplinary rehabilitation
Additional references
Guasti L et al. Cardiovascular Diseases, Prevention, and Management of Complications in Older Adults After Hip Orthopaedic Interventions. European Journal of Preventive Cardiology. 2025
ESC consensus statement on cardiac management in hip fracture patients
PMID 39812215
Bartolotta RJ et al. ACR Appropriateness Criteria Acute Hip Pain: 2024 Update. Journal of the American College of Radiology. 2025
Imaging guideline for acute hip pain including occult fracture workup
Douketis JD et al. Perioperative Management of Antithrombotic Therapy: ACCP Clinical Practice Guideline. Chest. 2022
Evidence-based guidance for anticoagulation management around hip fracture surgery
Chen B et al. Effect of Oral Nutritional Supplementation on Outcomes in Older Adults With Hip Fractures. Bone and Joint Journal. 2023
Supports protein supplementation reducing complications by approximately 50%
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.