Treatment and rehabilitation after hip fracture in the elderly

Hip fracture is common in the elderly, and its incidence is predicted to increase in many countries. This article focuses on femoral neck and intertrochanteric fractures in the elderly, specifically discussing their classification, conservative and operative treatment, rehabilitation protocol, period of functional recovery, activities of daily living (ADL), instrumental activities of daily living (IADL), predictors for outcome, and health-related quality of life (HRQOL). The information was obtained from a Medline search of articles published in the English language literature. Femoral neck fractures should be classified into undisplaced and displaced fractures, and intertrochanteric fractures should be divided into stable and unstable fractures. Conservative treatment may be considered for undisplaced femoral neck and intertrochanteric fractures, but most of these fractures have been operated on. Immediate unrestricted weight bearing after surgery does not seem to increase the failure of any types of hip fracture. The appropriate intensity for rehabilitation is still controversial. Home-based rehabilitation with early discharge may be an alternative. Motor ADL, IADL, and HRQOL increase following hip fracture, but the majority of patients do not regain their prefracture levels. Statistical models with predictive accuracy from an independent sample are useful to predict functional outcome.