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Evidence based case report Managing an elderly patient with a fractured femur

My patient, an elderly woman, had been admitted to the trauma ward via the accident and emergency department on the previous day because she had sustained a trochanteric fracture of the left hip after a simple fall at home. She was in average health for someone of 82 and had a medical history that included hypertension, a myocardial infarction (three years previously), and a fractured wrist (eight years before). Since her husband's death she had lived alone in sheltered accommodation.

I needed to establish the extent to which her management could be evidence based and, where possible, to determine the optimum management using evidence based medicine. I also decided that I could spare no more than four hours to identify the evidence and that I should be able to do this from my office computer.

I used Medline, the Cochrane Library 1 and Best Evidence 2 (both on CD Rom), and the following internet sites: the NHS Centre for Reviews and Dissemination (nhscrd.york.ac.uk), the American Academy of Orthopedic Surgeons (www.aaos.org), Omni (www.omni.ac.uk), the Trip Database (http://www.ceres.uwcm.ac.uk/frameset.cfm?section=trip), the Scottish Intercollegiate Guidelines Network (SIGN; www.show.scot.nhs.uk/sign/home.htm), and Bandolier (www.jr2.ox.ac.uk/Bandolier). Unless otherwise indicated, I used the search term “hip fracture.” I found …