Arch Orthop Trauma Surg DOI 10.1007/s00402-011-1441-z 123 OSTEOPOROTIC FRACTURE MANAGEMENT Surgical treatment and management of hip fracture patients Antonio Moroni · Martha Hoque · James P. Waddell · Thomas A. Russell · Burkhard Wippermann · Gary DiGiovanni Received: 30 May 2011 © Springer-Verlag 2011 Abstract Introduction Osteoporosis-related hip fractures are asso- ciated with high mortality and costs. The optimum type of treatment for such fractures is controversial. To shed some light on this issue, the surgical treatment and management of osteoporotic hip fractures were discussed during a hip fracture surgical working group at the 2009 International Society For Fracture Repair Annual Meeting comprising leading experts in the Weld. Materials and methods The working group consisted of eight orthopaedic surgeons, six industry representatives and one research scientist. Eleven participants were from Europe and four were from the USA and Canada. Two chairmen posed 12 questions relating to the surgical treat- ment and management of osteoporotic hip fractures. Each question was discussed and key points were noted. Results Surgery should commence within 24–48 h but the patient should be optimized if presenting with ¸3 comorbidi- ties. Specialized centres integrating orthopaedics, geriatricians and rheumatologists could be a solution for the lack of spe- cialist care post-surgery. Surgical technique is important in fracture Wxation, as is the implant, but there has been no improvement in implant design in the past 50 years. As a con- sequence, malunion has become unjustiWably accepted. Frac- ture healing can be accelerated using pharmaceuticals which are also important in secondary prophylaxis. All displaced femoral neck fractures in geriatric patients should be treated with hip replacement, the choice between using cemented or uncemented Wxation being at the surgeon’s discretion. Discussion and conclusion This working group discus- sion highlighted several important issues which could be of interest to the orthopaedic community. Keywords Osteoporosis · Hip fracture · Surgical treatment · International Society For Fracture Repair Introduction Osteoporosis is a multifactorial skeletal disease resulting in bone fragility and risk of fracture, making it one of the main causes of disability, morbidity and mortality in the elderly [1]. It has been estimated that by the year 2050, the number of hip fractures worldwide will range between 7.3 and 21.3 million, at a cost of 100 billion Euro to the health care systems [2]. The 1-year mortality rate subsequent to a hip fracture has been estimated to be approximately 16% in subjects aged above 60 years, and up to 51% in nonagenarians [3, 4]. Although there is a general consensus with regard to the surgical treatment of undisplaced femoral neck fractures [5], the optimum type of treatment for displaced femoral A. Moroni (&) School of Sports Science, University of Bologna, Via G. C. Pupilli 1, 40136 Bologna, Italy e-mail: a.moroni@ior.it M. Hoque University of Bologna, Via G. C. Pupilli 1, 40136 Bologna, Italy J. P. Waddell St. Michael’s Hospital, Toronto, ON, Canada T. A. Russell University of Tennessee, Memphis, TN, USA B. Wippermann Klinikum Hildesheim GmbH, Hildesheim, Germany G. DiGiovanni Synthes Inc, West Chester, PA, USA