GeriatricsOrthopaedics
Hip Fracture Pathway
NICE CG124 + BPT — early surgery <36h, multidisciplinary, fascia iliaca block, pre-op optimisation, bone protection.
Source: NICE CG124; BPT
Step 1 of ~3
info
Initial Care
Mechanism: low-energy fall in elderly → groin pain, externally rotated + shortened limb, unable to weight bear.
• Plain XR: AP pelvis + lateral hip.
• If normal but high suspicion: MRI (preferred) or CT.
• Bloods: FBC, U&E, LFTs, glucose, CRP, group + cross-match, coag, ECG.
• Analgesia: paracetamol + opioid; FASCIA ILIACA BLOCK on admission — reduces opioid + delirium.
• IV fluids; NEWS2.
• Catheter only if essential.
• Pressure-area care.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Methylene Blue · Guanylate Cyclase / Nitric Oxide Pathway Inhibitor
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Sodium phenylbutyrate · Ammonia scavenger (alternative pathway)
- Alendronic Acid (Alendronate) · Bisphosphonate (bone resorption inhibitor)
- Marstacimab · Anti-tissue factor pathway inhibitor (TFPI) monoclonal antibody
- Indocyanine Green (Intravitreal Chromovitrectomy) · Diagnostic Dye — Vitreoretinal Surgery / ICG Angiography
Pathways
- Falls Assessment in Older Adults · NICE CG161 2013
- Delirium Outside ICU · NICE CG103
- Comprehensive Geriatric Assessment (CGA) · BGS / NICE
- Delirium Assessment and Management · NICE CG103 2010
- Frailty Recognition and Management · BGS Frailty Framework / NHS NHSE
- Polypharmacy and Medicines Optimisation · STOPP/START v2 2014 / NICE NG5
Decision support only. Always apply local guidelines and clinical judgement.