Femoral neck fractures in elderly subjects: Key principles of perioperative geriatric care

Background: Femoral neck fractures represent a significant public health challenge in the elderly, with annual global incidences exceeding 1.3 million. Despite surgical and anesthetic advancements, one-year mortality rates remain between 15% and 30%, often accompanied by severe functional decline, loss of autonomy, and high rates of institutionalization.

Objective: This article evaluates the clinical efficacy and implementation of the Perioperative Geriatric Care Unit (UPOG) model, a multidisciplinary approach designed to optimize outcomes for fragile patients through integrated orthopedic and geriatric management.

Key Points: The UPOG model utilizes standardized protocols to address the physiological vulnerability of patients over 70 years of age. Preoperative priorities include cognitive screening via tools like the CODEX test and ensuring surgical intervention occurs within 48 hours, as delays increase morbidity. Management of comorbidities—specifically anemia, electrolyte imbalances, and anticoagulation reversal—is essential. Postoperatively, the focus shifts to early mobilization, typically within 24 to 48 hours, to prevent delirium, pneumonia, and pressure ulcers. Systematic screening for undernutrition, pain management using behavioral scales, and secondary fall prevention through vitamin D and calcium supplementation are critical components. Evidence indicates this collaborative model reduces hospital length of stay, postoperative complications, and mortality rates at six months.

Conclusion: Integrated orthogeriatric care through dedicated units provides a superior framework for managing the complex needs of elderly patients with hip fractures. Success depends on rapid surgical stabilization, multidisciplinary comorbidity management, and early rehabilitation to maximize functional recovery and reduce long-term mortality.