Choice of Admitting Services for Older Adults with Hip Fracture

This Clinical Decisions case feature explores hospital admission pathways for older adults with hip fracture, presenting arguments for medicine vs. surgical service management. An 83-year-old woman with dementia, atrial fibrillation, acute kidney injury, and probable delirium is admitted with a femoral neck fracture. One expert advocates admission to a medicine service with orthopedic consultation, citing the need for complex medical management and data supporting improved outcomes in medically led care models. The alternative argument recommends admission to the orthopedic surgery service with medicine consultation, emphasizing timely surgical intervention and citing evidence from randomized trials showing reduced complications with early surgery. Both perspectives support multidisciplinary care and propose future models centered on perioperative specialists or orthogeriatric teams. The article highlights systemic tradeoffs between optimizing surgery timing and managing comorbidities, encouraging collaborative decision-making tailored to patient acuity and institutional resources.

This Clinical Decisions case feature explores hospital admission pathways for older adults with hip fracture, presenting arguments for medicine vs. surgical service management. An 83-year-old woman with dementia, atrial fibrillation, acute kidney injury, and probable delirium is admitted with a femoral neck fracture. One expert advocates admission to a medicine service with orthopedic consultation, citing the need for complex medical management and data supporting improved outcomes in medically led care models. The alternative argument recommends admission to the orthopedic surgery service with medicine consultation, emphasizing timely surgical intervention and citing evidence from randomized trials showing reduced complications with early surgery. Both perspectives support multidisciplinary care and propose future models centered on perioperative specialists or orthogeriatric teams. The article highlights systemic tradeoffs between optimizing surgery timing and managing comorbidities, encouraging collaborative decision-making tailored to patient acuity and institutional resources.