Switzer, J.A.

There are substantial research knowledge gaps regarding orthopaedic outcomes after surgical procedures to treat hip fractures in vulnerable elderly patients. The article by Heng et al. serves to remind us that treating hip fractures must be done thoughtfully. Given the risks related to surgical hip fracture treatment, attention should be paid to treatment decisions for subgroups of high-risk patients. Not all older patients are equally likely to benefit from standard orthopaedic care. Some older adults are at high risk for inpatient hospital complications such as delirium, particularly those with prefracture cognitive impairment. Geriatric hip fractures are associated with high morbidity, mortality, and prolonged functional impairment. At least one-third of patients die within 1 year after a hip fracture and less than one-half ever regain their prefracture level of function. Given this trajectory, efforts such as cognitive screening and other measures of frailty can provide useful insights in planning treatment.