Management of Acute Hip Fracture
N ENGL J MED 377;21



Worldwide, 4.5 million people are disabled from hip fractures eace year,…


It is estimated that by 2050, more than 50% of all osteoporotic fractures will occur in Asia.

どんどん煽ってくる。・・・本当か? NEJMはアジアを意識しすぎじゃないか? 食いっぱぐれないようなので、どんどん整形外科医になってアジアに出かけましょう。

The mortality rate within 1 year after hip fracture is as high as 36%,… This rate has remained relatively stable over time, in contrast to declining mortality rates associated with other causes, such as acute myocardial infarction.



the time from hospital admission to surgery to as little as6 hours is associated with a greater reduction in the incidence of postoperative complications

6時間以内に手術できるのが理想ですよね。・・・えっ48時間じゃなくて??? どんどん早くなりますね。本当に、ここまで早いのが有効か”a large international trial”が実施されているそうです。リスク評価に手間取って時間を食うのが良くあるパターン。難しい時代です。

Rating of hip function after follow-up periods of 12 to 48 months also were consistently better after total hip arthroplasty than hemiarthroplasty.


For fractures that are deemed to be stable, randomized trials comparing these implants have shown no significant difference in functional outcomes, but sliding hip screws are more cost-effective than intramedullary nails.

安定型の転子部骨折にはsliding hip screws派の私には心強い言葉。とはいえ、ちょっとでも骨片が回ってたらネイルを使います。


the administration of bisphosphonates has not been associated with deleterious effects on fracture healing