Pathological hip fracture in the elderly: review and proposal of an algorithm

Objective. Current Italian guidelines recommend surgery within 24 hours from admission for hip fractures of the elderly. In such patients, a pathologic fracture of the proximal femur is not an uncommon event and may be consequent to bone metastases or primary tumours. This paper aims to investigate the current literature and to propose an algorithm to manage patients more securely. Methods. A review of the literature on diagnostic and therapeutic tools in pathologic fractures of the hip was conducted. Evidence from the literature was merged to define a flowchart for a safe clinical-diagnostic pathway. Results. Proper imaging is essential in the management of bone metastases, along with appropriate laboratory tests and within a multi-disciplinary setting. While bone metastases are the expression of a systemic disease, bone sarcomas have an extremely aggressive local course and an incorrect surgical procedure could heavily affect prognosis of the patient. The surgeon should not rush to treat a suspicion of a pathological fracture without having performed all necessary investigations. Conclusions. Orthopaedists must doubt a pathologic fracture. An algorithm could help standardise procedures and provide a tool for safe management of these patients.