Intertrochanteric patterns influenced by trochanteric muscle pull
Subtrochanteric deforming forces
Proximal fragment flexion and abduction tendency
Distal fragment adduction tendency
Therapeutic Considerations
Operative selection rationale
Femoral neck
Nondisplaced often fixation approach
Displaced in older adult often arthroplasty approach
Intertrochanteric
Stable patterns may allow sliding hip screw
Unstable patterns often cephalomedullary nail
Subtrochanteric
Intramedullary fixation often preferred
Malreduction risk high without traction and alignment control
Complications
Femoral neck
AVN risk
Nonunion risk
Intertrochanteric
Implant cutout risk with poor reduction
Varus collapse risk
Medical complications
Delirium
Pneumonia
VTE
Patient Discharge Instructions
Copy discharge instructions
Discharge packet
Return precautions
Increasing pain not controlled by prescribed plan
New numbness or weakness in foot
Cold or pale foot
Chest pain or shortness of breath
Fever or wound drainage if wound present
Mobility and weight bearing
Non-weight bearing unless explicitly cleared
Walker or crutches use instruction
Pain plan
Acetaminophen schedule
Opioid only for breakthrough pain
Swelling care
Elevation as tolerated
Ice over lateral hip 15 to 20 minutes at a time if helpful
Follow-up plan
Orthopedics appointment timeframe provided
Repeat imaging plan if symptoms worsen
Fall prevention
Remove tripping hazards
Night lighting
Avoid sedating substances
References
Clinical guidelines and evidence sources
Core guidance
AAOS Clinical Practice Guideline on Management of Hip Fractures in Older Adults
Early surgery guidance statements
Multimodal analgesia and regional anesthesia support
NICE guideline on hip fracture management
Surgery timing targets
Orthogeriatric co-management recommendations
BOAST guidance for hip fracture care pathway
Standardized admission to theatre process
VTE prophylaxis recommendations
Procedural and ED practice
ACEP clinical policy and guidance on procedural sedation and analgesia
Capnography recommendation level labeling
Monitoring and airway readiness guidance
Classification references
Garden classification for intracapsular femoral neck fractures
Displacement stratification
Treatment implication linkage
Pauwels classification for femoral neck shear angle
Nonunion risk correlation
Fixation stability considerations
AO/OTA 31-A proximal femur classification
Intertrochanteric stability grouping
Implant selection implications
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.