What is the role of medications in the treatment of hip fractures?

Updated: Jan 08, 2019
  • Author: Naveenpal S Bhatti, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

Nearly all patients with a femoral fracture are in significant pain, and parenteral analgesia should always be a consideration. Preoperative prophylactic antibiotics are recommended for the patient undergoing immediate internal fixation, with the usual dose being 1 g of a first-generation cephalosporin.

Prophylactic antibiotics are also indicated for open fractures. In a clean laceration smaller than 1 cm, an IV bolus of 1 g of a first-generation cephalosporin is adequate. An antibiotic that covers gram-negative organisms should be added for a laceration larger than 1 cm. With a laceration that has an extensive soft-tissue injury or appears moderately contaminated, 1.5 mg/kg of gentamicin or tobramycin should also be added. If the laceration appears grossly contaminated, penicillin should be added to cover clostridial infections.

The results from one study of elderly patients (65 y and older) noted that opioid analgesia can be used for postoperative hip surgery pain control without concern for a direct link to postoperative delirium. [13]


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