Lonkkamurtuma
Käypä hoito -suositus |  Julkaistu: 2017-10-16   | Tila: voimassa  |  Aihepiiri(t): Geriatria, Kirurgia, Kuntoutus, Ortopedia ja traumatologia, Yleislääketiede
Mikä on Käypä hoito -suositus?
Suomalaisen Lääkäriseuran Duodecimin ja Suomen Ortopediyhdistyksen asettama työryhmä
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Lonkkamurtuma

Käypä hoito
16.10.2017
Suomalaisen Lääkäriseuran Duodecimin ja Suomen Ortopediyhdistyksen asettama työryhmä

Opi ja ota käyttöön

Koosteet

Potilaalle

Muut suositukset

 

Miten viitata Käypä hoito -suositukseen? «»1

Keskeinen sanoma

  • Lonkkamurtuma on vakava iäkkäiden kaatumisvamma. Se johtaa usein liikunta- ja toimintakyvyn heikentymiseen, ja lonkkamurtumapotilaiden kuolleisuus on suuri. Yhteiskunnan kannalta lonkkamurtumat ovat merkityksellisimpiä avuntarpeeseen ja pitkäaikaishoitoon johtavia sairauksia. Suomessa leikataan vuosittain noin 6 000 lonkkamurtumaa.
  • Lonkkamurtuman riskiä voidaan pienentää puuttumalla kaatumisriskiä suurentaviin ja luun lujuutta heikentäviin tekijöihin.
    • Iäkkäiden kaatumisriski pitää tunnistaa. Tämä koskee varsinkin iäkkäitä, joilla on jo ollut kaatumisia. Heidän tilanteensa tulee arvioida laaja-alaisesti, ja kaatumisriskiä suurentaviin tekijöihin tulee puuttua.
  • Lonkkamurtumapotilaan kivun tehokas hoito luo pohjan mobilisaatiolle ja auttaa ehkäisemään komplikaatioita. Kivun hoito käsittää kipulääkityksen ja johtopuudutukset.
  • Lonkkamurtumaleikkaus voidaan tehdä yleisanestesiassa tai spinaalipuudutuksessa.
  • Leikkaus on tehtävä viivytyksettä sellaisella menetelmällä, joka mahdollistaa täyspainovarauksen.
  • Mobilisaatio tulee aloittaa heti leikkauksen jälkeen. Liikuntaharjoittelun tulee sisältää myös progressiivista lihasvoimaharjoittelua.
  • Lonkkamurtumapotilaiden ennustetta voidaan parantaa ja hoidon kustannuksia pienentää keskittämällä lonkkamurtumapotilaiden hoito ja kuntoutus vanhusten sairauksiin perehtyneisiin yksiköihin. Moniammatillisesta geriatrisesta kuntoutuksesta hyötyvät myös muistisairaat lonkkamurtumapotilaat.
  • Lonkkamurtuman jälkeen on ehkäistävä aktiivisesti uusia luunmurtumia. Tärkeintä on selvittää ensimmäisen lonkkamurtuman syyt ja puuttua kaatumisriskiä suurentaviin tekijöihin. Lisäksi on huolehdittava kalsiumin ja D-vitamiinin riittävästä saannista ja harkittava osteoporoosin lääkehoitoa.
  • Lonkkamurtumapotilaiden hyväksi tehtävä työ on moniammatillista ja edellyttää siten sujuvaa yhteistyötä ja tiedonkulkua eri ammattilaisten kesken. Kuntoutus suunnitellaan potilaan lähtökohdista ja hänen tavoitteidensa mukaisesti. Potilaan läheiset otetaan aktiivisesti mukaan kuntoutukseen.

Aiheen rajaus

  • Suositus koskee kaatumisen tai matalalta putoamisen seurauksena syntyneitä reisiluun yläosan murtumia aikuisilla.

Tavoitteet

  • Suosituksen tavoitteena on edistää lonkkamurtumien ehkäisyä sekä lonkkamurtumapotilaiden laaja-alaista hoitoa ja heidän toimintakykynsä palautumista.

Kohderyhmä

  • Suositus on tarkoitettu kaikille lonkkamurtumapotilaiden hoitoon osallistuville sosiaali- ja terveydenhuollon ammattilaisille ja päättäjille.

Epidemiologia

Taulukko 1. Kotona asuneiden miesten ja naisten ensimmäisen lonkkamurtuman ikäryhmittäinen ilmaantuvuus (100 000 henkilöä kohti), 90 vrk:n kuluessa kotiutuneiden osuus (%) ja kuolleisuus vuoden seurannassa (%) Suomessa (vuonna 2014) «PERFECT. Lonkkamurtuma 2017; Available from: https://www.thl.fi/fi/tutkimus-ja-asiantuntijatyo/hankkeet-ja-ohjelmat/perfect/osahankkeet/lonkkamurtuma »1
Alle 60v 60–64 v 65–69 v 70–74 v 75–79 v 80–84 v 85–89 v 90–94 v Yli 94 v
Miehet
Ilmaantuvuus 28 64 100 144 284 458 872 1373 1535
Kotona 90 vrk:n kuluttua murtumasta 94 87 77 73 72 60 54 51 55
Kuolleisuus vuoden seurannassa 6,4 9,6 18,3 19,8 26,2 29,1 36,4 42,1 36,4
Naiset
Ilmaantuvuus 24 55 90 148 364 723 1130 1616 1235
Kotona 90 vrk:n kuluttua murtumasta 90 89 92 88 83 73 67 56 58
Kuolleisuus vuoden seurannassa 10,0 7,3 6,5 10,4 10,2 16,8 19,9 31,8 33,7

Lonkkamurtumien merkitys

Riskitekijät

Taulukko 2. Lonkkamurtuman tärkeimmät riskitekijät
Korkea ikä «Taylor BC, Schreiner PJ, Stone KL ym. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 2004;52:1479-86 »18, «Benetos IS, Babis GC, Zoubos AB ym. Factors affecting the risk of hip fractures. Injury 2007;38:735-44 »25, «Stolee P, Poss J, Cook RJ ym. Risk factors for hip fracture in older home care clients. J Gerontol A Biol Sci Med Sci 2009;64:403-10 »26
Murtumat vanhemmilla «Kanis JA, Johansson H, Oden A ym. A family history of fracture and fracture risk: a meta-analysis. Bone 2004;35:1029-37 »27
Aiempi murtuma:
- rannemurtuma (naisilla)
«Taylor BC, Schreiner PJ, Stone KL ym. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 2004;52:1479-86 »18, «Benetos IS, Babis GC, Zoubos AB ym. Factors affecting the risk of hip fractures. Injury 2007;38:735-44 »25, «Kanis JA, Johnell O, De Laet C ym. A meta-analysis of previous fracture and subsequent fracture risk. Bone 2004;35:375-82 »28
«Johnson NA, Stirling ER, Divall P ym. Risk of hip fracture following a wrist fracture-A meta-analysis. Injury 2017;48:399-405 »29
Heikentynyt liikuntakyky ja lihasheikkous
(kävelynopeus, tuoliltanousu, puristusvoima)
«Taylor BC, Schreiner PJ, Stone KL ym. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 2004;52:1479-86 »18, «Cawthon PM, Fullman RL, Marshall L ym. Physical performance and risk of hip fractures in older men. J Bone Miner Res 2008;23:1037-44 »30, «Caillet P, Klemm S, Ducher M ym. Hip fracture in the elderly: a re-analysis of the EPIDOS study with causal Bayesian networks. PLoS One 2015;10:e0120125 »31, «Zhu K, Devine A, Lewis JR ym. "'Timed up and go' test and bone mineral density measurement for fracture prediction. Arch Intern Med 2011;171:1655-61 »32
Tupakointi «Shen GS, Li Y, Zhao G ym. Cigarette smoking and risk of hip fracture in women: a meta-analysis of prospective cohort studies. Injury 2015;46:1333-40 »33
Runsas alkoholinkäyttö «Zhang X, Yu Z, Yu M ym. Alcohol consumption and hip fracture risk. Osteoporos Int 2015;26:531-42 »34
D-vitamiinin puute «Looker AC. Serum 25-hydroxyvitamin D and risk of major osteoporotic fractures in older U.S. adults. J Bone Miner Res 2013;28:997-1006 »35, «Buchebner D, McGuigan F, Gerdhem P ym. Vitamin D insufficiency over 5 years is associated with increased fracture risk-an observational cohort study of elderly women. Osteoporos Int 2014;25:2767-75 »36, «Steingrimsdottir L, Halldorsson TI, Siggeirsdottir K ym. Hip fractures and bone mineral density in the elderly--importance of serum 25-hydroxyvitamin D. PLoS One 2014;9:e91122 »37
Huono ravitsemustila, pieni painoindeksi «Benetos IS, Babis GC, Zoubos AB ym. Factors affecting the risk of hip fractures. Injury 2007;38:735-44 »25, «Stolee P, Poss J, Cook RJ ym. Risk factors for hip fracture in older home care clients. J Gerontol A Biol Sci Med Sci 2009;64:403-10 »26, «Johansson H, Kanis JA, Odén A ym. A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 2014;29:223-33 »38
Diabetes (erityisesti tyypin 1) «Benetos IS, Babis GC, Zoubos AB ym. Factors affecting the risk of hip fractures. Injury 2007;38:735-44 »25, «Dytfeld J, Michalak M. Type 2 diabetes and risk of low-energy fractures in postmenopausal women: meta-analysis of observational studies. Aging Clin Exp Res 2017;29:301-309 »39, «Fan Y, Wei F, Lang Y ym. Diabetes mellitus and risk of hip fractures: a meta-analysis. Osteoporos Int 2016;27:219-28 »40
Aivoverenkiertohäiriöt «Benetos IS, Babis GC, Zoubos AB ym. Factors affecting the risk of hip fractures. Injury 2007;38:735-44 »25, «Luan L, Li R, Wang Z ym. Stroke increases the risk of hip fracture: a systematic review and meta-analysis. Osteoporos Int 2016;27:3149-3154 »41
Parkinsonin tauti «Taylor BC, Schreiner PJ, Stone KL ym. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 2004;52:1479-86 »18, «Stolee P, Poss J, Cook RJ ym. Risk factors for hip fracture in older home care clients. J Gerontol A Biol Sci Med Sci 2009;64:403-10 »26
Heikko näkökyky (erityisesti huono syvyysnäkö ja rajoittunut näkökenttä) «Taylor BC, Schreiner PJ, Stone KL ym. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 2004;52:1479-86 »18, «Ivers RQ, Cumming RG, Mitchell P ym. Visual risk factors for hip fracture in older people. J Am Geriatr Soc 2003;51:356-63 »42, «Coleman AL, Cummings SR, Ensrud KE ym. Visual field loss and risk of fractures in older women. J Am Geriatr Soc 2009;57:1825-32 »43
Muistisairaus:
- Alzheimerin tauti
«Taylor BC, Schreiner PJ, Stone KL ym. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 2004;52:1479-86 »18, «Stolee P, Poss J, Cook RJ ym. Risk factors for hip fracture in older home care clients. J Gerontol A Biol Sci Med Sci 2009;64:403-10 »26, «Guo Z, Wills P, Viitanen M ym. Cognitive impairment, drug use, and the risk of hip fracture in persons over 75 years old: a community-based prospective study. Am J Epidemiol 1998;148:887-92 »44
«Baker NL, Cook MN, Arrighi HM ym. Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988-2007. Age Ageing 2011;40:49-54 »45, «Tolppanen AM, Lavikainen P, Soininen H ym. Incident hip fractures among community dwelling persons with Alzheimer's disease in a Finnish nationwide register-based cohort. PLoS One 2013;8:e59124 »46
Lääkkeiden käyttö:
- bentsodiatsepiinit ja unilääkkeet
- masennuslääkkeet
- psykoosilääkkeet
- opioidit
- PPI-lääkkeet

«Benetos IS, Babis GC, Zoubos AB ym. Factors affecting the risk of hip fractures. Injury 2007;38:735-44 »25, «Park SM, Ryu J, Lee DR ym. Zolpidem use and risk of fractures: a systematic review and meta-analysis. Osteoporos Int 2016;27:2935-44 »47, «Bakken MS, Engeland A, Engesæter LB ym. Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study. Eur J Clin Pharmacol 2014;70:873-80 »48
«Oderda LH, Young JR, Asche CV ym. Psychotropic-related hip fractures: meta-analysis of first-generation and second-generation antidepressant and antipsychotic drugs. Ann Pharmacother 2012;46:917-28 »49, «Bakken MS, Engeland A, Engesæter LB ym. Increased risk of hip fracture among older people using antidepressant drugs: data from the Norwegian Prescription Database and the Norwegian Hip Fracture Regis»50
«Oderda LH, Young JR, Asche CV ym. Psychotropic-related hip fractures: meta-analysis of first-generation and second-generation antidepressant and antipsychotic drugs. Ann Pharmacother 2012;46:917-28 »49, «Lee SH, Hsu WT, Lai CC ym. Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017;28:1167-1178 »51, «Bakken MS, Schjøtt J, Engeland A ym. Antipsychotic Drugs and Risk of Hip Fracture in People Aged 60 and Older in Norway. J Am Geriatr Soc 2016;64:1203-9 »52
«Ping F, Wang Y, Wang J ym. Opioids increase hip fracture risk: a meta-analysis. J Bone Miner Metab 2017;35:289-297 »53
«Zhou B, Huang Y, Li H ym. Proton-pump inhibitors and risk of fractures: an update meta-analysis. Osteoporos Int 2016;27:339-47 »54
Laitoksessa asuminen «Brennan nee Saunders J, Johansen A, Butler J ym. Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff. Osteoporos Int 2003;14:515-9 »23, «Norton R, Campbell AJ, Reid IR ym. Residential status and risk of hip fracture. Age Ageing 1999;28:135-9 »55
Myös hypertyreoosin «Blum MR, Bauer DC, Collet TH ym. Subclinical thyroid dysfunction and fracture risk: a meta-analysis. JAMA 2015;313:2055-65 »56, keliakian «Heikkilä K, Pearce J, Mäki M ym. Celiac disease and bone fractures: a systematic review and meta-analysis. J Clin Endocrinol Metab 2015;100:25-34 »57, keuhkoahtaumataudin «Huang SW, Wang WT, Chou LC ym. Chronic Obstructive Pulmonary Disease Increases the Risk of Hip Fracture: A Nationwide Population-Based Cohort Study. Sci Rep 2016;6:23360 »58, nivelreuman «van Staa TP, Geusens P, Bijlsma JW ym. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 2006;54:3104-12 »59 ja MS-taudin «Bazelier MT, van Staa T, Uitdehaag BM ym. The risk of fracture in patients with multiple sclerosis: the UK general practice research database. J Bone Miner Res 2011;26:2271-9 »60, «Bazelier MT, van Staa TP, Uitdehaag BM ym. Risk of fractures in patients with multiple sclerosis: a population-based cohort study. Neurology 2012;78:1967-73 »61 on raportoitu altistavan lonkkamurtumille.
Taulukko 3. Lonkkamurtuman arvioitu todennäköisyys (%) 10 vuoden aikana ruotsalaisilla miehillä ja naisilla iän ja reisiluun kaulan luuntiheyden T-arvon mukaan «Johnell O, Kanis JA, Oden A ym. Predictive value of BMD for hip and other fractures. J Bone Miner Res 2005;20:1185-94 »22
T-arvo
Ikä (v) Miehet Naiset
–1 –2 < –3 –1 –2 < –3
50 0,7 2,6 9,1 0,3 0,9 3,1
60 1,0 2,5 6,6 0,8 2,3 6,7
70 2,7 5,4 10,5 2,1 5,2 12,8
80 6,4 10,0 15,3 4,6 9,7 19,8

Murtuman riskitekijäanalyysi

Ensimmäisen lonkkamurtuman ehkäisy

  • Lonkkamurtumien ehkäisyn perustana ovat taustalla olevien sairauksien tunnistaminen ja niiden hyvä hoito, monipuolinen ravinto, fyysinen aktiivisuus, kaatumisten ehkäisy sekä osteoporoosin ehkäisy ja hoito.
    • Erityisesti tulee kiinnittää huomiota henkilöihin, joilla on ollut aikaisemmin murtumia. Aiemmista murtumista tulee huomioida myös nikamamurtumat, jotka voivat ilmetä hyvin vähäisin oirein tai jotka voidaan todeta vain sattumalöydöksenä (Käypä hoito -suositus Osteoporoosi «Osteoporoosi»7).
  • Lonkkamurtumien ehkäisy edellyttää monipuolisia väestötason toimenpiteitä, jotka kohdistuvat vanhusväestöön ja erityisessä murtumavaarassa oleviin (taulukko «Lonkkamurtuman ehkäisyssä huomioitavia tekijöitä»4).
Taulukko 4. Lonkkamurtuman ehkäisyssä huomioitavia tekijöitä
Tausta-aineistoa
Koko väestö
Terveyden ja toimintakyvyn edistäminen
Liikunta «Peel NM, Bartlett HP, McClure RJ. Healthy aging as an intervention to minimize injury from falls among older people. Ann N Y Acad Sci 2007;1114:162-9 »67, «Schmitt NM, Schmitt J, Dören M. The role of physical activity in the prevention of osteoporosis in postmenopausal women-An update. Maturitas 2009;63:34-8 »68, «Karinkanta S, Piirtola M, Sievänen H ym. Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol 2010;6:396-407 »69, «Säännöllinen, vähintään kohtalainen fyysinen harjoittelu on yhteydessä pienempään lonkkamurtumariskiin yli 50-vuotiailla.»A
D-vitamiinin ja kalsiumin riittävä saanti Käypä hoito -suositus Osteoporoosi «Osteoporoosi»7, «Sawka AM, Ismaila N, Cranney A ym. A scoping review of strategies for the prevention of hip fracture in elderly nursing home residents. PLoS One 2010;5:e9515 »70
Tupakointi ja alkoholinkäyttö «Shen GS, Li Y, Zhao G ym. Cigarette smoking and risk of hip fracture in women: a meta-analysis of prospective cohort studies. Injury 2015;46:1333-40 »33, «Peel NM, Bartlett HP, McClure RJ. Healthy aging as an intervention to minimize injury from falls among older people. Ann N Y Acad Sci 2007;1114:162-9 »67
Vanhukset
Raihnaisuuden esto, luun terveyden säilyttäminen, tapaturmien esto
Liikunta «Karinkanta S, Piirtola M, Sievänen H ym. Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol 2010;6:396-407 »69, «McClure R, Turner C, Peel N ym. Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev 2005;1:CD004441 »71, «Korpelainen R, Keinänen-Kiukaanniemi S, Nieminen P ym. Long-term outcomes of exercise: follow-up of a randomized trial in older women with osteopenia. Arch Intern Med 2010;170:1548-56 »72, «Rong K, Liu XY, Wu XH ym. Increasing Level of Leisure Physical Activity Could Reduce the Risk of Hip Fracture in Older Women: A Dose-Response Meta-analysis of Prospective Cohort Studies. Medicine (Bal»73, «Säännöllinen, vähintään kohtalainen fyysinen harjoittelu on yhteydessä pienempään lonkkamurtumariskiin yli 50-vuotiailla.»A
Murtumien estoon tähtäävä terveysneuvonta «Pekkarinen T, Löyttyniemi E, Välimäki M. Hip fracture prevention with a multifactorial educational program in elderly community-dwelling Finnish women. Osteoporos Int 2013;24:2983-92 »74
Ravitsemus «Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical pract»75
Ympäristön turvallisuus «Frick KD, Kung JY, Parrish JM ym. Evaluating the cost-effectiveness of fall prevention programs that reduce fall-related hip fractures in older adults. J Am Geriatr Soc 2010;58:136-41 »76
Suuressa lonkkamurtumavaarassa olevat
Varhaiset toimenpiteet toimintakyvyn säilyttämiseksi
Lääkityksen tarkistus «Tinetti ME, Baker DI, King M ym. Effect of dissemination of evidence in reducing injuries from falls. N Engl J Med 2008;359:252-61 »77, «Ham AC, Swart KM, Enneman AW ym. Medication-related fall incidents in an older, ambulant population: the B-PROOF study. Drugs Aging 2014;31:917-27 »78
Osteoporoosin hoito Käypä hoito -suositus Osteoporoosi «Osteoporoosi»7
Kävely- ja voimaharjoitukset «Karinkanta S, Piirtola M, Sievänen H ym. Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol 2010;6:396-407 »69, «Tinetti ME, Baker DI, King M ym. Effect of dissemination of evidence in reducing injuries from falls. N Engl J Med 2008;359:252-61 »77, «Palveluasunnoissa asuvien vanhuksien yksilöllinen kävely- ja tasapainoharjoitusohjelma saattaa vähentää kaatumisia ja lonkkamurtumia.»C
Tasapainoharjoitteet «Frick KD, Kung JY, Parrish JM ym. Evaluating the cost-effectiveness of fall prevention programs that reduce fall-related hip fractures in older adults. J Am Geriatr Soc 2010;58:136-41 »76
Lonkkasuojaimet «Oliver D, Connelly JB, Victor CR, ym. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ (Clinical resea»79, «Sawka AM, Boulos P, Beattie K ym. Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis. J Clin Epidemiol 2007;60:336-44 »80, «Lonkkasuojaimet saattavat vähentää lonkkamurtumia pitkäaikaisessa laitoshoidossa tai palveluasunnoissa asuvilla, erityisen korkean kaatumisriskin omaavilla iäkkäillä henkilöillä.»C
Liikkumisen apuvälineet «Karinkanta S, Piirtola M, Sievänen H ym. Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol 2010;6:396-407 »69

Kaatumisriskin arviointi

Taulukko 5. Lonkkamurtumavaarassa olevien iäkkäiden tutkiminen
Pitkäaikaissairauksien ja elintapojen huomiointi
  • muistisairauden ja masennuksen tunnistaminen
  • virtsainkontinenssi, nokturia
  • diabetes: onko hypoglykemioita?
  • alkoholin käyttö
Lääkityksen arviointi
  • bentsodiatsepiinit, unilääkkeet, opioidit, psykoosilääkkeet, masennuslääkkeet, epilepsialääkkeet
  • vanhuksille haitalliset lääkkeet (Internet-linkki: Lääke 75+ -tietokanta «http://www.fimea.fi/laakehaut_ja_luettelot/laake75-»6)
  • verenpainetta laskevat lääkkeet (ortostatismi)
Näkökyky
  • Onko toimintakykyä haittaavaa näön heikentymistä?
  • Onko näkökenttäpuutoksia?
Verenpaine
  • ortostaattinen hypotensio: systolisen verenpaineen lasku 20 mmHg tai diastolisen verenpaineen lasku 10 mmHg 3 minuutin kuluessa seisomaan nousun jälkeen
  • osana kollapsiselvittelyä tarvittaessa kallistuskoe (tilt test)
Verenkiertoelimistö
  • sydämen johtumis- ja rytmihäiriöt (EKG:n pitkäaikaisrekisteröinti, jos vahva epäily rytmihäiriöstä)
Neurologinen tutkimus
  • kognitio: MMSE, kellotesti
  • perifeerinen neuropatia, heikentynyt proprioseptiikka
Tasapainon hallinta, kävely ja lihasvoima
Tuki- ja liikuntaelimistö
  • nivelten liikkeet ja liikerajoitukset, erityisesti alaraajat ja kaularanka
  • jalkaterien deformiteetit, kovettumat
Kodin ja ympäristön riskitekijät
Osteoporoosilääkityksen tarpeen arviointi

Kaatumisten ehkäisy

Taulukko 6. Kaatumisia ehkäiseviä toimenpiteitä
Tausta-aineistoa
Kotona asuvat 65 vuotta täyttäneet henkilöt
Liikuntaharjoittelu, joka sisältää voima-, tasapaino- ja koordinaatioharjoittelua sekä yleistä liikunta-aktiivisuutta «Karinkanta S, Piirtola M, Sievänen H ym. Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol 2010;6:396-407 »69, «Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical pract»75, «Gillespie LD, Robertson MC, Gillespie WJ ym. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9:CD007146 »92, «Hill KD, Hunter SW, Batchelor FA ym. Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis. Maturitas 201»102
Monipuolinen ravitsemus, D-vitamiinin ja kalsiumin riittävä saanti, päihteettömyys ja terveelliset elämäntavat «Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical pract»75, «Palvanen M, Kannus P, Piirtola M ym. Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: a randomised controlled trial. Injury 2014;45:265-71 »97
Kodin vaaratekijöiden kartoitus ja minimoiminen sekä apuvälineet «Gillespie LD, Robertson MC, Gillespie WJ ym. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9:CD007146 »92
Lääkityksen tarkistus ja saneeraus «Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical pract»75, «Gillespie LD, Robertson MC, Gillespie WJ ym. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9:CD007146 »92
Näkökyvyn kartoitus ja ensimmäisen kaihileikkauksen tekeminen tarvittaessa «Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical pract»75, «Gillespie LD, Robertson MC, Gillespie WJ ym. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9:CD007146 »92
Ortostaattisen hypotension tunnistaminen ja hoito «Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical pract»75
Sydämen rytmihäiriöiden hoito «Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical pract»75
Jalkojen hoito, kengät ja liukuesteet «Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical pract»75, «Gillespie LD, Robertson MC, Gillespie WJ ym. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9:CD007146 »92, «McKiernan FE. A simple gait-stabilizing device reduces outdoor falls and nonserious injurious falls in fall-prone older people during the winter. J Am Geriatr Soc 2005;53:943-7 »103, «Spink MJ, Menz HB, Fotoohabadi MR ym. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial. B»104
Laitoshoidossa olevat iäkkäät henkilöt
Yksilölliset, monialaiset interventiot «Cameron ID, Gillespie LD, Robertson MC ym. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2012;12:CD005465 »91, «Stubbs B, Denkinger MD, Brefka S ym. What works to prevent falls in older adults dwelling in long term care facilities and hospitals? An umbrella review of meta-analyses of randomised controlled trial»98
Muistisairaat henkilöt
Liikunta «Chan WC, Yeung JW, Wong CS ym. Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: a systematic review and meta-analysis. J Am Med Dir Assoc 2015;16:149-54 »105
(Tutkimusnäyttö muista toimenpiteistä on ristiriitaista.)

Osteoporoosin ehkäisy ja hoito

Lonkkasuojaimet

Lonkkamurtuman diagnoosi ja luokitus

Diagnoosi

Reisiluun yläosan murtumien luokitus

  • Reisiluun yläosan murtumien jaottelu ja luokitus esitetään kuvassa «Reisiluun yläosan murtumien jaottelu ja luokitus (ICD 10)»1 .
  • Reisiluun kaulan murtumat jaetaan dislokoitumattomiin ja dislokoituneisiin.
  • Trokanteerisissa murtumissa murtumalinja tai -linjat kulkevat sarvennoisten kautta tai niiden välissä mutta pienen sarvennoisen alareunan tason yläpuolella.
    • Trokanteeristen murtumien lukuisista luokituksista merkittävin on karkea jako stabiileihin ja instabiileihin.
    • Tavallisimmin käytetyssä AO/ASIF-luokituksessa stabiilia murtumaa vastaa pääluokka A1 (mediaalinen tuki jäljellä).
    • Instabiilia trokanteerista murtumaa taas vastaavat pääluokat A2 (pirstalemurtuma, jossa mediaalinen ja dorsaalinen tuki puuttuu) ja A3 (transtrokanteerinen murtuma, jossa murtumalinja ulottuu lateraaliseen korteksiin, tai käänteinen trokanteerinen murtuma) (kuva «Trokanteeriset murtumat AO-luokituksen mukaan»2 ).
  • Subtrokanteerisissa murtumissa murtumalinjat kulkevat sarvennoisalueen alapuolella pienestä sarvennoisesta korkeintaan 5 cm distaalisuuntaan.

Lonkkamurtumapotilaan hoidon ja kuntoutuksen järjestäminen

Lonkkamurtumapotilaan arviointi ennen leikkausta

Kivun hoito

Kivun hoidon merkitys

Kivun hoidon merkitys

Akuutin murtuman aiheuttama kipu ja leikkauskipu

Kivun lääkehoito akuuttivaiheen jälkeen

Anestesia

Tromboosiprofylaksi

Muu perioperatiivinen hoito

Lonkkamurtuman kirurginen hoito

Reisiluun kaulan dislokoitumattoman murtuman hoito

Reisiluun kaulan dislokoituneen murtuman hoito

Trokanteerisen murtuman leikkaushoito

Subtrokanteerisen murtuman leikkaushoito

Varausluvat ja röntgenkuvausseuranta

Leikkauksenjälkeinen hoito

Mobilisaatio

Delirium

Lonkkamurtumapotilaan äkillisen sekavuustilan ehkäisy ja hoito

Ravitsemus

Anabolisten steroidien käyttö

Lonkkamurtumapotilaan kaatumisten ja uusien lonkkamurtumien ehkäisy

Lonkkamurtuman jälkeinen osteoporoosin diagnostiikka ja hoito

Diagnostiikka

  • Lonkkamurtumapotilaan osteoporoosin hoito voidaan aloittaa ilman luuntiheysmittausta, kunhan syöpä ja muut sekundaarisen osteoporoosin syyt on suljettu pois (Käypä hoito -suositus Osteoporoosi «Osteoporoosi»7).
    • Diagnostiikassa tulee olla mahdollisuus sisätautilääkärin tai geriatrin konsultaatioon.

Kalsium ja D-vitamiini

Osteoporoosilääkitys

Lonkkamurtumapotilaan kuntoutus

  • Laaja-alaisen ja moniammatillisen kuntoutuksen avulla voidaan kohentaa toimintakykyä, edistää terveyttä ja antaa voimavaroja elämän hallintaan. Lonkkamurtumapotilaan kuntoutuksen tavoitteena on palauttaa toimintakyky mahdollisimman nopeasti sellaiseksi, että hän voi jatkaa elämäänsä entisessä elinympäristössään.

Kuntoutus moniammatillisessa geriatrisessa kuntoutusyksikössä

Muistisairaiden ja neurologisten potilaiden kuntoutuksen erityispiirteet

Kotiutuminen ja kuntoutus avohoidossa

Lonkkamurtumapotilaiden ennusteeseen vaikuttavat tekijät

Taulukko 7. Lonkkamurtumapotilaiden ennusteeseen vaikuttavat tekijät
Heikentää toimintakykyä ja/tai elämänlaatua Lisää kuolleisuutta
Potilaaseen liittyvät tekijät
Korkea ikä «Pajulammi HM, Pihlajamäki HK, Luukkaala TH ym. Pre- and perioperative predictors of changes in mobility and living arrangements after hip fracture--a population-based study. Arch Gerontol Geriatr 2015»6, «Gjertsen JE, Baste V, Fevang JM ym. Quality of life following hip fractures: results from the Norwegian hip fracture register. BMC Musculoskelet Disord 2016;17:265 »275 «Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269, «Smith T, Pelpola K, Ball M ym. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014;43:464-71 »270
Miessukupuoli «Haentjens P, Magaziner J, Colón-Emeric CS ym. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010;152:380-90 »11, «Katsoulis M, Benetou V, Karapetyan T ym. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med 2017;281:300-310 »13, «Panula J, Pihlajamäki H, Mattila VM ym. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord 2011;12:105 »14, «Piirtola M, Vahlberg T, Löppönen M ym. Fractures as predictors of excess mortality in the aged-a population-based study with a 12-year follow-up. Eur J Epidemiol 2008;23:747-55 »15, «Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269
Naissukupuoli «Peeters CM, Visser E, Van de Ree CL ym. Quality of life after hip fracture in the elderly: A systematic literature review. Injury 2016;47:1369-82 »7
Pitkäaikaissairaudet:
- ASA-luokka, Charlsonin indeksi
- diabetes
- sydänsairaus
- krooninen keuhkosairaus
- syöpäsairaus
«Peeters CM, Visser E, Van de Ree CL ym. Quality of life after hip fracture in the elderly: A systematic literature review. Injury 2016;47:1369-82 »7 «Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269
«Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269, «Smith T, Pelpola K, Ball M ym. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014;43:464-71 »270
«Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269
«Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269
«Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269
«Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269
Muistisairaus «Vochteloo AJ, Borger van der Burg BL, Tuinebreijer WE ym. Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients? Geriatr Gerontol Int 2013;13:190-7 »5, «Pajulammi HM, Pihlajamäki HK, Luukkaala TH ym. Pre- and perioperative predictors of changes in mobility and living arrangements after hip fracture--a population-based study. Arch Gerontol Geriatr 2015»6, «Häkkinen A, Heinonen M, Kautiainen H ym. Effect of cognitive impairment on basic activities of daily living in hip fracture patients: a 1-year follow-up. Aging Clin Exp Res 2007;19:139-44 »276 «Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269, «Smith T, Pelpola K, Ball M ym. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014;43:464-71 »270
Suuri lääkemäärä «Pajulammi HM, Luukkaala TH, Pihlajamäki HK ym. Decreased glomerular filtration rate estimated by 2009 CKD-EPI equation predicts mortality in older hip fracture population. Injury 2016;47:1536-42 »141, «Smith T, Pelpola K, Ball M ym. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014;43:464-71 »270
Anemia «Laulund AS, Lauritzen JB, Duus BR ym. Routine blood tests as predictors of mortality in hip fracture patients. Injury 2012;43:1014-20 »277
Munuaisten vajaatoiminta «Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269, «Pajulammi HM, Luukkaala TH, Pihlajamäki HK ym. Decreased glomerular filtration rate estimated by 2009 CKD-EPI equation predicts mortality in older hip fracture population. Injury 2016;47:1536-42 »141, «Laulund AS, Lauritzen JB, Duus BR ym. Routine blood tests as predictors of mortality in hip fracture patients. Injury 2012;43:1014-20 »277
Vajaaravitsemustila (ja vajaaravitsemuksen riski) (pieni painoindeksi, pieni albumiinipitoisuus tai ravitsemustilan arvioinnin perusteella) «Peeters CM, Visser E, Van de Ree CL ym. Quality of life after hip fracture in the elderly: A systematic literature review. Injury 2016;47:1369-82 »7, «Nuotio M, Tuominen P, Luukkaala T. Association of nutritional status as measured by the Mini-Nutritional Assessment Short Form with changes in mobility, institutionalization and death after hip fractu»226, «Goisser S, Schrader E, Singler K ym. Malnutrition According to Mini Nutritional Assessment Is Associated With Severe Functional Impairment in Geriatric Patients Before and up to 6 Months After Hip Fra»278 «Nuotio M, Tuominen P, Luukkaala T. Association of nutritional status as measured by the Mini-Nutritional Assessment Short Form with changes in mobility, institutionalization and death after hip fractu»226, «Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269, «Laulund AS, Lauritzen JB, Duus BR ym. Routine blood tests as predictors of mortality in hip fracture patients. Injury 2012;43:1014-20 »277
Murtumaa edeltänyt heikko liikunta- ja toimintakyky «Vochteloo AJ, Borger van der Burg BL, Tuinebreijer WE ym. Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients? Geriatr Gerontol Int 2013;13:190-7 »5, «Pajulammi HM, Pihlajamäki HK, Luukkaala TH ym. Pre- and perioperative predictors of changes in mobility and living arrangements after hip fracture--a population-based study. Arch Gerontol Geriatr 2015»6, «Peeters CM, Visser E, Van de Ree CL ym. Quality of life after hip fracture in the elderly: A systematic literature review. Injury 2016;47:1369-82 »7 «Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269, «Smith T, Pelpola K, Ball M ym. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014;43:464-71 »270
Laitoshoito tai palveluasuminen «Dyer SM, Crotty M, Fairhall N ym. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016;16:158 »4, «Vochteloo AJ, Borger van der Burg BL, Tuinebreijer WE ym. Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients? Geriatr Gerontol Int 2013;13:190-7 »5, «Pajulammi HM, Pihlajamäki HK, Luukkaala TH ym. Pre- and perioperative predictors of changes in mobility and living arrangements after hip fracture--a population-based study. Arch Gerontol Geriatr 2015»6 «Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269, «Smith T, Pelpola K, Ball M ym. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014;43:464-71 »270
Murtumaan ja sen hoitoon liittyvät tekijät
Trokanteerinen murtuma «Gjertsen JE, Baste V, Fevang JM ym. Quality of life following hip fractures: results from the Norwegian hip fracture register. BMC Musculoskelet Disord 2016;17:265 »275 «Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 »269, «Smith T, Pelpola K, Ball M ym. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014;43:464-71 »270
Leikkaushoidon toteutuminen yli 1 vrk murtuman jälkeen «Ensimmäisen vuorokauden kuluessa leikatuilla lonkkamurtumapotilailla ilmeisesti on pienempi kuolleisuus ja vähemmän komplikaatioita verrattuna pidempään odotusaikaan.»B
Internifiksaatio (verrattuna tekoniveleen) «Peeters CM, Visser E, Van de Ree CL ym. Quality of life after hip fracture in the elderly: A systematic literature review. Injury 2016;47:1369-82 »7
Kova leikkauksenjälkeinen kipu «Peeters CM, Visser E, Van de Ree CL ym. Quality of life after hip fracture in the elderly: A systematic literature review. Injury 2016;47:1369-82 »7
Delirium «Vochteloo AJ, Borger van der Burg BL, Tuinebreijer WE ym. Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients? Geriatr Gerontol Int 2013;13:190-7 »5, «Marcantonio E, Ta T, Duthie E ym. Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. J Am Geriatr Soc 2002;50:850-7 »212, «Krogseth M, Wyller TB, Engedal K ym. Delirium is a risk factor for institutionalization and functional decline in older hip fracture patients. J Psychosom Res 2014;76:68-74 »273 «Radinovic K, Markovic-Denic L, Dubljanin-Raspopovic E ym. Estimating the effect of incident delirium on short-term outcomes in aged hip fracture patients through propensity score analysis. Geriatr Ger»271, «Bellelli G, Mazzola P, Morandi A ym. Duration of postoperative delirium is an independent predictor of 6-month mortality in older adults after hip fracture. J Am Geriatr Soc 2014;62:1335-40 »279, «Mazzola P, Bellelli G, Broggini V ym. Postoperative delirium and pre-fracture disability predict 6-month mortality among the oldest old hip fracture patients. Aging Clin Exp Res 2015;27:53-60 »280
Leikkauskomplikaatiot «Peeters CM, Visser E, Van de Ree CL ym. Quality of life after hip fracture in the elderly: A systematic literature review. Injury 2016;47:1369-82 »7
Liikuntakyvyn hidas palautuminen leikkauksen jälkeen «Heinonen M, Karppi P, Huusko T ym. Post-operative degree of mobilization at two weeks predicts one-year mortality after hip fracture. Aging Clin Exp Res 2004;16:476-80 »268
≤ 10 vrk:n kokonaishoitojakso «Nordström P, Gustafson Y, Michaëlsson K ym. Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ 2015;350:h696 »132

Suomalaisen Lääkäriseuran Duodecimin ja Suomen Ortopediyhdistyksen asettama työryhmä

Lonkkamurtuma-suosituksen historiatiedot «Lonkkamurtuma, Käypä hoito -suosituksen historiatiedot»5

Puheenjohtaja:

Tiina Huusko, LT, sisätautien ja geriatrian erikoislääkäri; Espoo

Kokoava kirjoittaja:

Esa Jämsen, LT, dosentti, geriatrian erikoislääkäri, geriatrian kliininen opettaja, tutkija; Tampereen kaupunki, Hatanpään sairaala, TAYS, Tampereen yliopisto ja Tekonivelsairaala Coxa

Jäsenet:

Hannu Kokki, LT, anestesiologian professori; Itä-Suomen yliopisto, KYS

Minna Laitinen, dosentti, ortopedian ja traumatologian osastonylilääkäri; TAYS:n TULES-vastuualue ja Tekonivelsairaala Coxa

Pia Laukkanen, LT, dosentti; Jyväskylä

Antti Malmivaara, LKT, dosentti, fysiatrian erikoislääkäri, ylilääkäri; Terveyden ja hyvinvoinnin laitos, Käypä hoito -toimittaja

Maarit Piirtola, FT, Tutkijatohtori, fysioterapeutti; Helsingin yliopiston sosiaalitieteiden laitos ja Suomen molekyylilääketieteen instituutti (FIMM)

Ville-Valtteri Välimäki, LT, dosentti, ortopedian ja traumatologian erikoislääkäri, vastuulääkäri; HYKS Jorvin sairaala, ortopedia

Ville Mattila, dosentti, vs. ortopedian ja traumatologian professori, ylilääkäri, ortopedi; Tampereen yliopisto, TAYS ja Tekonivelsairaala Coxa, Käypä hoito -toimittaja

Asiantuntija:

Mikko Peltola, FT, erikoistutkija; Terveyden ja hyvinvoinnin laitos

Sidonnaisuudet

Tiina Huusko: Asiantuntijapalkkio (Sosiaali- ja terveysministeriö), Suomen luustoliitto ry:n hallituksen jäsen.

Esa Jämsen: Apuraha (Tampereen Lääkäripäivät, Valtion tutkimusrahoitus), Asiantuntijapalkkio (Diabetesliitto, Suomen Lääkärilehti, Van Rens Foundation of the Netherlands Orthopaedic Association), Työsuhde (Tekonivelsairaala Coxa, 10 % tutkijan tehtävä), Luentopalkkio (Fioca, Suomalainen Lääkäriseura Duodecim, Suomen Endoproteesihoitajat, Suomen Lääkäriliitto), Muu palkkio (Suomen Geriatrit ry:n tuki eurooppalaiseen geriatrian postgraduate-koulutukseen osallistumiseen), Suomen akuuttigeriatrian yhdistyksen sihteeri.

Hannu Kokki: Apuraha (Pfizer), Asiantuntijapalkkio (Fysioline Pharma, Pohjois-Savon shp, Ratiopharm), Työsuhde (Fressi oy), Luentopalkkio (Aesculap Academy, Baxter, Fresenius-Kabi, LeoPharma, Professio), Lisenssitulo tai tekijänpalkkio (Duodecim), Osakeomistus (Oriola, Orion Oyj), Korvaukset koulutus- ja kongressikuluista (MSD).

Minna Laitinen: Ei sidonnaisuuksia.

Pia Laukkanen: Osakeomistus (Oriola KDA ja B, Orion A ja B).

Antti Malmivaara: Ei sidonnaisuuksia.

Ville Mattila: Ei sidonnaisuuksia.

Maarit Piirtola: Tutkimusapuraha (Juho Vainion Säätiö), Asiantuntijapalkkio (Suomen Fysioterapeutit, UKK Terveyspalvelut), Luentopalkkio (Suomen Fysioterapeutit, Lahden AMK, Maito ja Terveys, Suomen Fysiogeriatria, TEHY ry, UKK Terveyspalvelut, UKK-instituutti/KaatumisSeula-hanke), Korvaukset koulutus- ja kongressikuluista (Luustoliitto, Työsuojelurahasto).

Ville-Valtteri Välimäki: Asiantuntijapalkkio (MSD, Oy Eli Lilly Finland AB), Luentopalkkio (Oy Eli Lilly Finland AB), Korvaukset koulutus- ja kongressikuluista (DePuySynthes, Karl Storz, Smith& nephew), Muu palkkio (Oy Eli Lilly Finland AB).

Kirjallisuusviite

Lonkkamurtuma. Suomalaisen Lääkäriseuran Duodecimin ja Suomen Ortopediyhdistyksen asettama työryhmä. Helsinki: Suomalainen Lääkäriseura Duodecim, 2017 (viitattu pp.kk.vvvv). Saatavilla internetissä: www.kaypahoito.fi

Tarkemmat viittausohjeet: «http://www.kaypahoito.fi/web/kh/viittaaminen»15

Vastuun rajaus

Käypä hoito -suositukset ovat parhaiden asiantuntijoiden laatimia yhteenvetoja yksittäisten sairauksien diagnostiikan ja hoidon vaikuttavuudesta. Ne eivät korvaa lääkärin tai muun terveydenhuollon ammattilaisen omaa arviota yksittäisen potilaan parhaasta mahdollisesta diagnostiikasta ja hoidosta hoitopäätöksiä tehtäessä.

Tiedonhakukäytäntö

Systemaattinen kirjallisuushaku on hoitosuosituksen perusta. Lue lisää artikkelista khk00007

Kirjallisuutta

  1. PERFECT. Lonkkamurtuma 2017; Available from: https://www.thl.fi/fi/tutkimus-ja-asiantuntijatyo/hankkeet-ja-ohjelmat/perfect/osahankkeet/lonkkamurtuma «https://www.thl.fi/fi/tutkimus-ja-asiantuntijatyo/hankkeet-ja-ohjelmat/perfect/osahankkeet/lonkkamurtuma»16
  2. Karampampa K, Ahlbom A, Michaëlsson K ym. Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival--A nationwide study of the Swedish population 60 years and older. Bone 2015;78:55-61 «PMID: 25933944»PubMed
  3. Lönnroos E, Kautiainen H, Karppi P ym. Incidence of second hip fractures. A population-based study. Osteoporos Int 2007;18:1279-85 «PMID: 17440675»PubMed
  4. Dyer SM, Crotty M, Fairhall N ym. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016;16:158 «PMID: 27590604»PubMed
  5. Vochteloo AJ, Borger van der Burg BL, Tuinebreijer WE ym. Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients? Geriatr Gerontol Int 2013;13:190-7 «PMID: 22686522»PubMed
  6. Pajulammi HM, Pihlajamäki HK, Luukkaala TH ym. Pre- and perioperative predictors of changes in mobility and living arrangements after hip fracture--a population-based study. Arch Gerontol Geriatr 2015;61:182-9 «PMID: 26043958»PubMed
  7. Peeters CM, Visser E, Van de Ree CL ym. Quality of life after hip fracture in the elderly: A systematic literature review. Injury 2016;47:1369-82 «PMID: 27178770»PubMed
  8. Nihtilä EK, Martikainen PT, Koskinen SV ym. Chronic conditions and the risk of long-term institutionalization among older people. Eur J Public Health 2008;18:77-84 «PMID: 17566001»PubMed
  9. Sund R, Juntunen M, Lüthje P ym. Monitoring the performance of hip fracture treatment in Finland. Ann Med 2011;43 Suppl 1:S39-46 «PMID: 21639716»PubMed
  10. Lönnroos E, Kautiainen H, Sund R ym. Utilization of inpatient care before and after hip fracture: a population-based study. Osteoporos Int 2009;20:879-86 «PMID: 18810302»PubMed
  11. Haentjens P, Magaziner J, Colón-Emeric CS ym. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010;152:380-90 «PMID: 20231569»PubMed
  12. von Friesendorff M, McGuigan FE, Wizert A ym. Hip fracture, mortality risk, and cause of death over two decades. Osteoporos Int 2016;27:2945-53 «PMID: 27172936»PubMed
  13. Katsoulis M, Benetou V, Karapetyan T ym. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med 2017;281:300-310 «PMID: 28093824»PubMed
  14. Panula J, Pihlajamäki H, Mattila VM ym. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord 2011;12:105 «PMID: 21599967»PubMed
  15. Piirtola M, Vahlberg T, Löppönen M ym. Fractures as predictors of excess mortality in the aged-a population-based study with a 12-year follow-up. Eur J Epidemiol 2008;23:747-55 «PMID: 18830674»PubMed
  16. Nurmi I, Lüthje P, Narinen A ym. [Treatment outcome and overall costs of femoral neck fractures]. Duodecim 2003;119:123-30 «PMID: 12607427»PubMed
  17. Nurmi I, Narinen A, Lüthje P ym. Cost analysis of hip fracture treatment among the elderly for the public health services: a 1-year prospective study in 106 consecutive patients. Arch Orthop Trauma Surg 2003;123:551-4 «PMID: 13680273»PubMed
  18. Taylor BC, Schreiner PJ, Stone KL ym. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 2004;52:1479-86 «PMID: 15341549»PubMed
  19. Ranhoff AH, Holvik K, Martinsen MI ym. Older hip fracture patients: three groups with different needs. BMC Geriatr 2010;10:65 «PMID: 20849652»PubMed
  20. Leavy B, Åberg AC, Melhus H ym. When and where do hip fractures occur? A population-based study. Osteoporos Int 2013;24:2387-96 «PMID: 23532356»PubMed
  21. Lönnroos E, Kautiainen H, Karppi P ym. Increased incidence of hip fractures. A population based-study in Finland. Bone 2006;39:623-7 «PMID: 16603427»PubMed
  22. Johnell O, Kanis JA, Oden A ym. Predictive value of BMD for hip and other fractures. J Bone Miner Res 2005;20:1185-94 «PMID: 15940371»PubMed
  23. Brennan nee Saunders J, Johansen A, Butler J ym. Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff. Osteoporos Int 2003;14:515-9 «PMID: 12730755»PubMed
  24. Rapp K, Becker C, Lamb SE ym. Hip fractures in institutionalized elderly people: incidence rates and excess mortality. J Bone Miner Res 2008;23:1825-31 «PMID: 18665785»PubMed
  25. Benetos IS, Babis GC, Zoubos AB ym. Factors affecting the risk of hip fractures. Injury 2007;38:735-44 «PMID: 17307178»PubMed
  26. Stolee P, Poss J, Cook RJ ym. Risk factors for hip fracture in older home care clients. J Gerontol A Biol Sci Med Sci 2009;64:403-10 «PMID: 19196903»PubMed
  27. Kanis JA, Johansson H, Oden A ym. A family history of fracture and fracture risk: a meta-analysis. Bone 2004;35:1029-37 «PMID: 15542027»PubMed
  28. Kanis JA, Johnell O, De Laet C ym. A meta-analysis of previous fracture and subsequent fracture risk. Bone 2004;35:375-82 «PMID: 15268886»PubMed
  29. Johnson NA, Stirling ER, Divall P ym. Risk of hip fracture following a wrist fracture-A meta-analysis. Injury 2017;48:399-405 «PMID: 27839795»PubMed
  30. Cawthon PM, Fullman RL, Marshall L ym. Physical performance and risk of hip fractures in older men. J Bone Miner Res 2008;23:1037-44 «PMID: 18302496»PubMed
  31. Caillet P, Klemm S, Ducher M ym. Hip fracture in the elderly: a re-analysis of the EPIDOS study with causal Bayesian networks. PLoS One 2015;10:e0120125 «PMID: 25822373»PubMed
  32. Zhu K, Devine A, Lewis JR ym. "'Timed up and go' test and bone mineral density measurement for fracture prediction. Arch Intern Med 2011;171:1655-61 «PMID: 21987195»PubMed
  33. Shen GS, Li Y, Zhao G ym. Cigarette smoking and risk of hip fracture in women: a meta-analysis of prospective cohort studies. Injury 2015;46:1333-40 «PMID: 25956674»PubMed
  34. Zhang X, Yu Z, Yu M ym. Alcohol consumption and hip fracture risk. Osteoporos Int 2015;26:531-42 «PMID: 25266483»PubMed
  35. Looker AC. Serum 25-hydroxyvitamin D and risk of major osteoporotic fractures in older U.S. adults. J Bone Miner Res 2013;28:997-1006 «PMID: 23184640»PubMed
  36. Buchebner D, McGuigan F, Gerdhem P ym. Vitamin D insufficiency over 5 years is associated with increased fracture risk-an observational cohort study of elderly women. Osteoporos Int 2014;25:2767-75 «PMID: 25116384»PubMed
  37. Steingrimsdottir L, Halldorsson TI, Siggeirsdottir K ym. Hip fractures and bone mineral density in the elderly--importance of serum 25-hydroxyvitamin D. PLoS One 2014;9:e91122 «PMID: 24621578»PubMed
  38. Johansson H, Kanis JA, Odén A ym. A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 2014;29:223-33 «PMID: 23775829»PubMed
  39. Dytfeld J, Michalak M. Type 2 diabetes and risk of low-energy fractures in postmenopausal women: meta-analysis of observational studies. Aging Clin Exp Res 2017;29:301-309 «PMID: 27072353»PubMed
  40. Fan Y, Wei F, Lang Y ym. Diabetes mellitus and risk of hip fractures: a meta-analysis. Osteoporos Int 2016;27:219-28 «PMID: 26264604»PubMed
  41. Luan L, Li R, Wang Z ym. Stroke increases the risk of hip fracture: a systematic review and meta-analysis. Osteoporos Int 2016;27:3149-3154 «PMID: 27185402»PubMed
  42. Ivers RQ, Cumming RG, Mitchell P ym. Visual risk factors for hip fracture in older people. J Am Geriatr Soc 2003;51:356-63 «PMID: 12588579»PubMed
  43. Coleman AL, Cummings SR, Ensrud KE ym. Visual field loss and risk of fractures in older women. J Am Geriatr Soc 2009;57:1825-32 «PMID: 19702619»PubMed
  44. Guo Z, Wills P, Viitanen M ym. Cognitive impairment, drug use, and the risk of hip fracture in persons over 75 years old: a community-based prospective study. Am J Epidemiol 1998;148:887-92 «PMID: 9801019»PubMed
  45. Baker NL, Cook MN, Arrighi HM ym. Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988-2007. Age Ageing 2011;40:49-54 «PMID: 21087990»PubMed
  46. Tolppanen AM, Lavikainen P, Soininen H ym. Incident hip fractures among community dwelling persons with Alzheimer's disease in a Finnish nationwide register-based cohort. PLoS One 2013;8:e59124 «PMID: 23527106»PubMed
  47. Park SM, Ryu J, Lee DR ym. Zolpidem use and risk of fractures: a systematic review and meta-analysis. Osteoporos Int 2016;27:2935-44 «PMID: 27105645»PubMed
  48. Bakken MS, Engeland A, Engesæter LB ym. Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study. Eur J Clin Pharmacol 2014;70:873-80 «PMID: 24810612»PubMed
  49. Oderda LH, Young JR, Asche CV ym. Psychotropic-related hip fractures: meta-analysis of first-generation and second-generation antidepressant and antipsychotic drugs. Ann Pharmacother 2012;46:917-28 «PMID: 22811347»PubMed
  50. Bakken MS, Engeland A, Engesæter LB ym. Increased risk of hip fracture among older people using antidepressant drugs: data from the Norwegian Prescription Database and the Norwegian Hip Fracture Registry. Age Ageing 2013;42:514-20 «PMID: 23438446»PubMed
  51. Lee SH, Hsu WT, Lai CC ym. Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017;28:1167-1178 «PMID: 28083669»PubMed
  52. Bakken MS, Schjøtt J, Engeland A ym. Antipsychotic Drugs and Risk of Hip Fracture in People Aged 60 and Older in Norway. J Am Geriatr Soc 2016;64:1203-9 «PMID: 27321599»PubMed
  53. Ping F, Wang Y, Wang J ym. Opioids increase hip fracture risk: a meta-analysis. J Bone Miner Metab 2017;35:289-297 «PMID: 27023332»PubMed
  54. Zhou B, Huang Y, Li H ym. Proton-pump inhibitors and risk of fractures: an update meta-analysis. Osteoporos Int 2016;27:339-47 «PMID: 26462494»PubMed
  55. Norton R, Campbell AJ, Reid IR ym. Residential status and risk of hip fracture. Age Ageing 1999;28:135-9 «PMID: 10350409»PubMed
  56. Blum MR, Bauer DC, Collet TH ym. Subclinical thyroid dysfunction and fracture risk: a meta-analysis. JAMA 2015;313:2055-65 «PMID: 26010634»PubMed
  57. Heikkilä K, Pearce J, Mäki M ym. Celiac disease and bone fractures: a systematic review and meta-analysis. J Clin Endocrinol Metab 2015;100:25-34 «PMID: 25279497»PubMed
  58. Huang SW, Wang WT, Chou LC ym. Chronic Obstructive Pulmonary Disease Increases the Risk of Hip Fracture: A Nationwide Population-Based Cohort Study. Sci Rep 2016;6:23360 «PMID: 26987933»PubMed
  59. van Staa TP, Geusens P, Bijlsma JW ym. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 2006;54:3104-12 «PMID: 17009229»PubMed
  60. Bazelier MT, van Staa T, Uitdehaag BM ym. The risk of fracture in patients with multiple sclerosis: the UK general practice research database. J Bone Miner Res 2011;26:2271-9 «PMID: 21557309»PubMed
  61. Bazelier MT, van Staa TP, Uitdehaag BM ym. Risk of fractures in patients with multiple sclerosis: a population-based cohort study. Neurology 2012;78:1967-73 «PMID: 22592374»PubMed
  62. Waris VW, H.; Saarakkala, S.; Waris, P. Mikkelin osteoporoosi-indeksi tunnistaa rannemurtumapotilaiden luukadon. Suomen Lääkäril 2004;59(8):757-62
  63. Waris VJ, Sirola JP, Kiviniemi VV ym. Mikkeli Osteoporosis Index Identifies Fracture Risk Factors and Osteoporosis and Intervention Thresholds Parallel with FRAX. J Osteoporos 2011;2011:732560 «PMID: 21772977»PubMed
  64. Kanis JA, Johnell O, Oden A ym. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008;19:385-97 «PMID: 18292978»PubMed
  65. Kanis JA, Oden A, Johansson H ym. FRAX and its applications to clinical practice. Bone 2009;44:734-43 «PMID: 19195497»PubMed
  66. Sund R, Honkanen R, Johansson H ym. Evaluation of the FRAX model for hip fracture predictions in the population-based Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE). Calcif Tissue Int 2014;95:39-45 «PMID: 24792689»PubMed
  67. Peel NM, Bartlett HP, McClure RJ. Healthy aging as an intervention to minimize injury from falls among older people. Ann N Y Acad Sci 2007;1114:162-9 «PMID: 17986581»PubMed
  68. Schmitt NM, Schmitt J, Dören M. The role of physical activity in the prevention of osteoporosis in postmenopausal women-An update. Maturitas 2009;63:34-8 «PMID: 19356867»PubMed
  69. Karinkanta S, Piirtola M, Sievänen H ym. Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol 2010;6:396-407 «PMID: 20517287»PubMed
  70. Sawka AM, Ismaila N, Cranney A ym. A scoping review of strategies for the prevention of hip fracture in elderly nursing home residents. PLoS One 2010;5:e9515 «PMID: 20209088»PubMed
  71. McClure R, Turner C, Peel N ym. Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev 2005;1:CD004441 «PMID: 15674948»PubMed
  72. Korpelainen R, Keinänen-Kiukaanniemi S, Nieminen P ym. Long-term outcomes of exercise: follow-up of a randomized trial in older women with osteopenia. Arch Intern Med 2010;170:1548-56 «PMID: 20876406»PubMed
  73. Rong K, Liu XY, Wu XH ym. Increasing Level of Leisure Physical Activity Could Reduce the Risk of Hip Fracture in Older Women: A Dose-Response Meta-analysis of Prospective Cohort Studies. Medicine (Baltimore) 2016;95:e2984 «PMID: 26986111»PubMed
  74. Pekkarinen T, Löyttyniemi E, Välimäki M. Hip fracture prevention with a multifactorial educational program in elderly community-dwelling Finnish women. Osteoporos Int 2013;24:2983-92 «PMID: 23652464»PubMed
  75. Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 2011;59:148-57 «PMID: 21226685»PubMed
  76. Frick KD, Kung JY, Parrish JM ym. Evaluating the cost-effectiveness of fall prevention programs that reduce fall-related hip fractures in older adults. J Am Geriatr Soc 2010;58:136-41 «PMID: 20122044»PubMed
  77. Tinetti ME, Baker DI, King M ym. Effect of dissemination of evidence in reducing injuries from falls. N Engl J Med 2008;359:252-61 «PMID: 18635430»PubMed
  78. Ham AC, Swart KM, Enneman AW ym. Medication-related fall incidents in an older, ambulant population: the B-PROOF study. Drugs Aging 2014;31:917-27 «PMID: 25398701»PubMed
  79. Oliver D, Connelly JB, Victor CR, ym. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ (Clinical research ed.) 2007;334(7584):82
  80. Sawka AM, Boulos P, Beattie K ym. Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis. J Clin Epidemiol 2007;60:336-44 «PMID: 17346606»PubMed
  81. Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas 2013;75:51-61 «PMID: 23523272»PubMed
  82. Billington J, Fahey T, Galvin R. Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: a systematic review and meta-analysis. BMC Fam Pract 2012;13:76 «PMID: 22870921»PubMed
  83. Aranda-Gallardo M, Morales-Asencio JM, Canca-Sanchez JC ym. Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis. BMC Health Serv Res 2013;13:122 «PMID: 23547708»PubMed
  84. Tiedemann A, Sherrington C, Orr T ym. Identifying older people at high risk of future falls: development and validation of a screening tool for use in emergency departments. Emerg Med J 2013;30:918-22 «PMID: 23139096»PubMed
  85. Barry E, Galvin R, Keogh C ym. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr 2014;14:14 «PMID: 24484314»PubMed
  86. Cattelani L, Palumbo P, Palmerini L ym. FRAT-up, a Web-based fall-risk assessment tool for elderly people living in the community. J Med Internet Res 2015;17:e41 «PMID: 25693419»PubMed
  87. Matarese M, Ivziku D, Bartolozzi F ym. Systematic review of fall risk screening tools for older patients in acute hospitals. J Adv Nurs 2015;71:1198-209 «PMID: 25287867»PubMed
  88. Oliver D, Britton M, Seed P ym. Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. BMJ 1997;315:1049-53 «PMID: 9366729»PubMed
  89. Pajala S. Iäkkäiden kaatumisten ehkäisy 2012; Available from: http://urn.fi/URN:NBN:fi-fe201205085108 «http://urn.fi/URN:NBN:fi-fe201205085108»3
  90. Suomen Fysioterapeutit - Finlands Fysioterapeuter ry:n asettama työryhmä. Kaatumisten ja kaatumisvammojen ehkäisyn fysioterapiasuositus 2011; Available from: https://www.suomenfysioterapeutit.fi/index.php/fysioterapiasuositukset/kaatumisten-ja-kaatumisvammojen-ehkaisy «https://www.suomenfysioterapeutit.fi/index.php/fysioterapiasuositukset/kaatumisten-ja-kaatumisvammojen-ehkaisy»4
  91. Cameron ID, Gillespie LD, Robertson MC ym. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2012;12:CD005465 «PMID: 23235623»PubMed
  92. Gillespie LD, Robertson MC, Gillespie WJ ym. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9:CD007146 «PMID: 22972103»PubMed
  93. Karlsson MK, Magnusson H, von Schewelov T ym. Prevention of falls in the elderly--a review. Osteoporos Int 2013;24:747-62 «PMID: 23296743»PubMed
  94. Swift CG, Iliffe S. Assessment and prevention of falls in older people--concise guidance. Clin Med (Lond) 2014;14:658-62 «PMID: 25468853»PubMed
  95. Feskanich D, Willett W, Colditz G. Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA 2002;288:2300-6 «PMID: 12425707»PubMed
  96. Michaëlsson K, Olofsson H, Jensevik K ym. Leisure physical activity and the risk of fracture in men. PLoS Med 2007;4:e199 «PMID: 17579509»PubMed
  97. Palvanen M, Kannus P, Piirtola M ym. Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: a randomised controlled trial. Injury 2014;45:265-71 «PMID: 23579066»PubMed
  98. Stubbs B, Denkinger MD, Brefka S ym. What works to prevent falls in older adults dwelling in long term care facilities and hospitals? An umbrella review of meta-analyses of randomised controlled trials. Maturitas 2015;81:335-42 «PMID: 25935294»PubMed
  99. Rapp K, Lamb SE, Büchele G ym. Prevention of falls in nursing homes: subgroup analyses of a randomized fall prevention trial. J Am Geriatr Soc 2008;56:1092-7 «PMID: 18482303»PubMed
  100. Neyens JC, Dijcks BP, Twisk J ym. A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT). Age Ageing 2009;38:194-9 «PMID: 19221130»PubMed
  101. Evans LK, Strumpf NE, Allen-Taylor SL ym. A clinical trial to reduce restraints in nursing homes. J Am Geriatr Soc 1997;45:675-81 «PMID: 9180659»PubMed
  102. Hill KD, Hunter SW, Batchelor FA ym. Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis. Maturitas 2015;82:72-84 «PMID: 25989701»PubMed
  103. McKiernan FE. A simple gait-stabilizing device reduces outdoor falls and nonserious injurious falls in fall-prone older people during the winter. J Am Geriatr Soc 2005;53:943-7 «PMID: 15935015»PubMed
  104. Spink MJ, Menz HB, Fotoohabadi MR ym. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial. BMJ 2011;342:d3411 «PMID: 21680622»PubMed
  105. Chan WC, Yeung JW, Wong CS ym. Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: a systematic review and meta-analysis. J Am Med Dir Assoc 2015;16:149-54 «PMID: 25304179»PubMed
  106. Black DM, Cummings SR, Karpf DB ym. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996;348:1535-41 «PMID: 8950879»PubMed
  107. Cummings SR, Black DM, Thompson DE ym. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998;280:2077-82 «PMID: 9875874»PubMed
  108. Wells GA, Cranney A, Peterson J ym. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2008;1:CD001155 «PMID: 18253985»PubMed
  109. Cummings SR, San Martin J, McClung MR ym. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009;361:756-65 «PMID: 19671655»PubMed
  110. Rossouw JE, Anderson GL, Prentice RL ym. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321-33 «PMID: 12117397»PubMed
  111. Wells G, Cranney A, Peterson J ym. Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2008;1:CD004523 «PMID: 18254053»PubMed
  112. Reginster JY, Seeman E, De Vernejoul MC ym. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J Clin Endocrinol Metab 2005;90:2816-22 «PMID: 15728210»PubMed
  113. Black DM, Delmas PD, Eastell R ym. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007;356:1809-22 «PMID: 17476007»PubMed
  114. Iwamoto J, Takeda T, Matsumoto H. Efficacy of oral bisphosphonates for preventing hip fracture in disabled patients with neurological diseases: a meta-analysis of randomized controlled trials among the Japanese population. Curr Med Res Opin 2011;27:1141-8 «PMID: 21456887»PubMed
  115. Zhang W, Zhu C, Sun M ym. Efficacy of bisphosphonates against hip fracture in elderly patients with stroke and Parkinson diseases: meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis 2014;23:2714-24 «PMID: 25314942»PubMed
  116. Amiche MA, Albaum JM, Tadrous M ym. Efficacy of osteoporosis pharmacotherapies in preventing fracture among oral glucocorticoid users: a network meta-analysis. Osteoporos Int 2016;27:1989-98 «PMID: 26782683»PubMed
  117. Allen CS, Yeung JH, Vandermeer B ym. Bisphosphonates for steroid-induced osteoporosis. Cochrane Database Syst Rev 2016;10:CD001347 «PMID: 27706804»PubMed
  118. Santesso N, Carrasco-Labra A, Brignardello-Petersen R. Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev 2014;3:CD001255 «PMID: 24687239»PubMed
  119. Deutsch AL, Mink JH, Waxman AD. Occult fractures of the proximal femur: MR imaging. Radiology 1989;170:113-6 «PMID: 2909083»PubMed
  120. Quinn SF, McCarthy JL. Prospective evaluation of patients with suspected hip fracture and indeterminate radiographs: use of T1-weighted MR images. Radiology 1993;187:469-71 «PMID: 8475292»PubMed
  121. Evans PD, Wilson C, Lyons K. Comparison of MRI with bone scanning for suspected hip fracture in elderly patients. J Bone Joint Surg Br 1994;76:158-9 «PMID: 8300666»PubMed
  122. Pandey R, McNally E, Ali A ym. The role of MRI in the diagnosis of occult hip fractures. Injury 1998;29:61-3 «PMID: 9659484»PubMed
  123. Hakala MM, Eskelinen A, Toivonen J, ym. Kuntoutusosaston perustamisen vaikutus lonkkamurtumapotilaiden hoitotuloksiin Suomen Lääkäril 2014;69:319-23
  124. Swart E, Vasudeva E, Makhni EC ym. Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis. Clin Orthop Relat Res 2016;474:222-33 «PMID: 26260393»PubMed
  125. Sund R. Modeling the volume-effectiveness relationship in the case of hip fracture treatment in Finland. BMC Health Serv Res 2010;10:238 «PMID: 20707899»PubMed
  126. Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma 2014;28:e49-55 «PMID: 23912859»PubMed
  127. Hawley S, Javaid MK, Prieto-Alhambra D ym. Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study. Age Ageing 2016;45:236-42 «PMID: 26802076»PubMed
  128. Kristensen PK, Thillemann TM, Søballe K ym. Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study. Age Ageing 2016;45:66-71 «PMID: 26582757»PubMed
  129. Vidán M, Serra JA, Moreno C ym. Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 2005;53:1476-82 «PMID: 16137275»PubMed
  130. Middleton M, Wan B, da Assuncao R. Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models. Age Ageing 2016
  131. Killington M, Walker R, Crotty M. The chaotic journey: Recovering from hip fracture in a nursing home. Arch Gerontol Geriatr 2016;67:106-12 «PMID: 27483995»PubMed
  132. Nordström P, Gustafson Y, Michaëlsson K ym. Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ 2015;350:h696 «PMID: 25700551»PubMed
  133. Neuburger J, Currie C, Wakeman R ym. The impact of a national clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data. Med Care 2015;53:686-91 «PMID: 26172938»PubMed
  134. Sipilä S, Salpakoski A, Edgren J ym. Recovery of Lower Extremity Performance After Hip Fracture Depends on Prefracture and Postdischarge Mobility: A Subgroup Analysis of a Randomized Rehabilitation Trial. J Am Geriatr Soc 2016;64:e25-8 «PMID: 27459732»PubMed
  135. Moran CG, Wenn RT, Sikand M ym. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 2005;87:483-9 «PMID: 15741611»PubMed
  136. Purmonen T, Törmälehto S, Säävuori N ym. Budget impact analysis of warfarin reversal therapies among hip fracture patients in Finland. Drugs R D 2015;15:155-62 «PMID: 25749804»PubMed
  137. Doleman B, Moppett IK. Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression. Injury 2015;46:954-62 «PMID: 25818054»PubMed
  138. Kaukonen JP, Nurmi-Lüthje I, Lüthje P ym. Acute alcohol use among patients with acute hip fractures: a descriptive incidence study in southeastern Finland. Alcohol Alcohol 2006;41:345-8 «PMID: 16510531»PubMed
  139. Gregory JJ, Kostakopoulou K, Cool WP ym. One-year outcome for elderly patients with displaced intracapsular fractures of the femoral neck managed non-operatively. Injury 2010;41:1273-6 «PMID: 20630527»PubMed
  140. Moulton LS, Green NL, Sudahar T ym. Outcome after conservatively managed intracapsular fractures of the femoral neck. Ann R Coll Surg Engl 2015;97:279-82 «PMID: 26263935»PubMed
  141. Pajulammi HM, Luukkaala TH, Pihlajamäki HK ym. Decreased glomerular filtration rate estimated by 2009 CKD-EPI equation predicts mortality in older hip fracture population. Injury 2016;47:1536-42 «PMID: 27168083»PubMed
  142. Nordling P, Kiviniemi T, Strandberg M ym. Predicting the outcome of hip fracture patients by using N-terminal fragment of pro-B-type natriuretic peptide. BMJ Open 2016;6:e009416 «PMID: 26911583»PubMed
  143. Smeets SJ, Poeze M, Verbruggen JP. Preoperative cardiac evaluation of geriatric patients with hip fracture. Injury 2012;43:2146-51 «PMID: 22995981»PubMed
  144. Carson JL, Terrin ML, Noveck H ym. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011;365:2453-62 «PMID: 22168590»PubMed
  145. Leer-Salvesen S, Dybvik E, Dahl OE ym. Postoperative start compared to preoperative start of low-molecular-weight heparin increases mortality in patients with femoral neck fractures. Acta Orthop 2017;88:48-54 «PMID: 27658532»PubMed
  146. Frisch NB, Pepper AM, Jildeh TR ym. Intraoperative Hypothermia During Surgical Fixation of Hip Fractures. Orthopedics 2016;39:e1170-e1177 «PMID: 27536952»PubMed
  147. Hellström PM, Samuelsson B, Al-Ani AN ym. Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture: a pilot study. BMC Anesthesiol 2017;17:23 «PMID: 28202056»PubMed
  148. Dasch B, Endres HG, Maier C ym. Fracture-related hip pain in elderly patients with proximal femoral fracture after discharge from stationary treatment. Eur J Pain 2008;12:149-56 «PMID: 17475523»PubMed
  149. Walker-Bone K, Harvey NC, Ntani G ym. Chronic widespread bodily pain is increased among individuals with history of fracture: findings from UK Biobank. Arch Osteoporos 2016;11:1 «PMID: 26678491»PubMed
  150. Parker MJ, Griffiths R, Appadu BN. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database Syst Rev 2002;1:CD001159 «PMID: 11869594»PubMed
  151. Morrison RS, Magaziner J, Gilbert M ym. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 2003;58:76-81 «PMID: 12560416»PubMed
  152. Abou-Setta AM, Beaupre LA, Rashiq S ym. Comparative effectiveness of pain management interventions for hip fracture: a systematic review. Ann Intern Med 2011;155:234-45 «PMID: 21844549»PubMed
  153. Chin RP, Ho CH, Cheung LP. Scheduled analgesic regimen improves rehabilitation after hip fracture surgery. Clin Orthop Relat Res 2013;471:2349-60 «PMID: 23543417»PubMed
  154. Network SIG. Management of hip fracture in older people. A national clinical guideline. 2009
  155. Morrison RS, Siu AL. A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. J Pain Symptom Manage 2000;19:240-8 «PMID: 10799790»PubMed
  156. McDermott JH, Nichols DR, Lovell ME. A case-control study examining inconsistencies in pain management following fractured neck of femur: an inferior analgesia for the cognitively impaired. Emerg Med J 2014;31:e2-8 «PMID: 24136118»PubMed
  157. Jensen-Dahm C, Palm H, Gasse C ym. Postoperative Treatment of Pain after Hip Fracture in Elderly Patients with Dementia. Dement Geriatr Cogn Disord 2016;41:181-91 «PMID: 27045590»PubMed
  158. Leino KA, Kuusniemi KS, Lertola KK ym. Comparison of four pain scales in patients with hip fracture or other lower limb trauma. Acta Anaesthesiol Scand 2011;55:495-502 «PMID: 21288225»PubMed
  159. DeWaters T, Faut-Callahan M, McCann JJ ym. Comparison of self-reported pain and the PAINAD scale in hospitalized cognitively impaired and intact older adults after hip fracture surgery. Orthop Nurs 2008;27:21-8 «PMID: 18300684»PubMed
  160. Cuvillon P, Ripart J, Debureaux S ym. [Analgesia after hip fracture repair in elderly patients: the effect of a continuous femoral nerve block: a prospective and randomised study]. Ann Fr Anesth Reanim 2007;26:2-9 «PMID: 17142005»PubMed
  161. Bollinger AJ, Butler PD, Nies MS ym. Is Scheduled Intravenous Acetaminophen Effective in the Pain Management Protocol of Geriatric Hip Fractures? Geriatr Orthop Surg Rehabil 2015;6:202-8 «PMID: 26328237»PubMed
  162. Handoll HH, Queally JM, Parker MJ. Pre-operative traction for hip fractures in adults. Cochrane Database Syst Rev 2011;12:CD000168 «PMID: 22161361»PubMed
  163. Niskanen RO, Strandberg N. Bedside femoral block performed on the first postoperative day after unilateral total knee arthroplasty: a randomized study of 49 patients. J Knee Surg 2005;18:192-6 «PMID: 16152867»PubMed
  164. Godoy Monzón D, Vazquez J, Jauregui JR ym. Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesics. Int J Emerg Med 2010;3:321-5 «PMID: 21373300»PubMed
  165. Soinikoski M, Kuusniemi K, Jalonen J ym. A national survey into perioperative anesthetic management of patients with a fractured neck of femur. BMC Anesthesiol 2012;12:14 «PMID: 22839198»PubMed
  166. Kokki M, Välitalo P, Rasanen I ym. Absorption of different oral dosage forms of oxycodone in the elderly: a cross-over clinical trial in patients undergoing cystoscopy. Eur J Clin Pharmacol 2012;68:1357-63 «PMID: 22451244»PubMed
  167. Kuusniemi K, Zöllner J, Sjövall S ym. Prolonged-release oxycodone/naloxone in postoperative pain management: from a randomized clinical trial to usual clinical practice. J Int Med Res 2012;40:1775-93 «PMID: 23206459»PubMed
  168. Solomon DH, Rassen JA, Glynn RJ ym. The comparative safety of opioids for nonmalignant pain in older adults. Arch Intern Med 2010;170:1979-86 «PMID: 21149754»PubMed
  169. Möller J, Laflamme L, Söderberg Löfdal K. CYP2D6-inhibiting drugs and the increased risk of fall-related injuries due to newly initiated opioid treatment--a Swedish, register-based case-crossover study. Basic Clin Pharmacol Toxicol 2015;116:134-9 «PMID: 24975450»PubMed
  170. Biboulet P, Jourdan A, Van Haevre V ym. Hemodynamic profile of target-controlled spinal anesthesia compared with 2 target-controlled general anesthesia techniques in elderly patients with cardiac comorbidities. Reg Anesth Pain Med 2012;37:433-40 «PMID: 22609644»PubMed
  171. Olofsson C, Nygårds EB, Bjersten AB ym. Low-dose bupivacaine with sufentanil prevents hypotension after spinal anesthesia for hip repair in elderly patients. Acta Anaesthesiol Scand 2004;48:1240-4 «PMID: 15504182»PubMed
  172. Handoll HH, Farrar MJ, McBirnie J ym. Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev 2002;4:CD000305 «PMID: 12519540»PubMed
  173. Breivik H, Bang U, Jalonen J ym. Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 2010;54:16-41 «PMID: 19839941»PubMed
  174. Gillespie WJ, Walenkamp GH. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev 2010;3:CD000244 «PMID: 20238310»PubMed
  175. Uçkay I, Hoffmeyer P, Lew D ym. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. J Hosp Infect 2013;84:5-12 «PMID: 23414705»PubMed
  176. Bryson DJ, Morris DL, Shivji FS ym. Antibiotic prophylaxis in orthopaedic surgery: difficult decisions in an era of evolving antibiotic resistance. Bone Joint J 2016;98-B:1014-9 «PMID: 27482011»PubMed
  177. Cordero-Ampuero J, de Dios M. What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties? Clin Orthop Relat Res 2010;468:3268-77 «PMID: 20544319»PubMed
  178. Raivio MK, O.; Pitkälä, K.; Tilvis, R. Rehabilitation Outcome in Hip-Fracture: Impact of Weight-Bearing Restriction–A Preliminary Investigation. Phys Occup Ther Geriatr 2005;22(4)
  179. Nyholm AM, Gromov K, Palm H ym. Time to Surgery Is Associated with Thirty-Day and Ninety-Day Mortality After Proximal Femoral Fracture: A Retrospective Observational Study on Prospectively Collected Data from the Danish Fracture Database Collaborators. J Bone Joint Surg Am 2015;97:1333-9 «PMID: 26290084»PubMed
  180. Lewis PM, Waddell JP. When is the ideal time to operate on a patient with a fracture of the hip? : a review of the available literature. Bone Joint J 2016;98-B:1573-1581 «PMID: 27909117»PubMed
  181. Lee HB, Mears SC, Rosenberg PB ym. Predisposing factors for postoperative delirium after hip fracture repair in individuals with and without dementia. J Am Geriatr Soc 2011;59:2306-13 «PMID: 22188077»PubMed
  182. Krogseth M, Watne LO, Juliebø V ym. Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients. Arch Gerontol Geriatr 2016;64:38-44 «PMID: 26952375»PubMed
  183. Gjertsen JE, Fevang JM, Matre K ym. Clinical outcome after undisplaced femoral neck fractures. Acta Orthop 2011;82:268-74 «PMID: 21619501»PubMed
  184. Siavashi B, Aalirezaei A, Moosavi M ym. A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults. Int Orthop 2015;39:2069-71 «PMID: 26152248»PubMed
  185. Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev 2006;4:CD001708 «PMID: 17054139»PubMed
  186. Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ 2007;335:1251-4 «PMID: 18056740»PubMed
  187. Leonardsson O, Sernbo I, Carlsson A ym. Long-term follow-up of replacement compared with internal fixation for displaced femoral neck fractures: results at ten years in a randomised study of 450 patients. J Bone Joint Surg Br 2010;92:406-12 «PMID: 20190313»PubMed
  188. Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 2010;6:CD001706 «PMID: 20556753»PubMed
  189. Rogmark C, Fenstad AM, Leonardsson O ym. Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients. Acta Orthop 2014;85:18-25 «PMID: 24460108»PubMed
  190. Hopley C, Stengel D, Ekkernkamp A ym. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review. BMJ 2010;340:c2332 «PMID: 20543010»PubMed
  191. Avery PP, Baker RP, Walton MJ ym. Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. J Bone Joint Surg Br 2011;93:1045-8 «PMID: 21768626»PubMed
  192. Baker RP, Squires B, Gargan MF ym. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg Am 2006;88:2583-9 «PMID: 17142407»PubMed
  193. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 2010;9:CD000093 «PMID: 20824825»PubMed
  194. Pajarinen J, Lindahl J, Savolainen V ym. Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures. Int Orthop 2004;28:347-53 «PMID: 15597171»PubMed
  195. Hsu CE, Chiu YC, Tsai SH ym. Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls. Injury 2015;46:1047-53 «PMID: 25890863»PubMed
  196. Matre K, Havelin LI, Gjertsen JE ym. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register. Injury 2013;44:735-42 «PMID: 23305689»PubMed
  197. Koval KJ, Friend KD, Aharonoff GB ym. Weight bearing after hip fracture: a prospective series of 596 geriatric hip fracture patients. J Orthop Trauma 1996;10:526-30 «PMID: 8915913»PubMed
  198. Raaymakers EL. The non-operative treatment of impacted femoral neck fractures. Injury 2002;33 Suppl 3:C8-14 «PMID: 12423585»PubMed
  199. Kim JW, Byun SE, Chang JS. The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in elderly patients. Arch Orthop Trauma Surg 2014;134:941-6 «PMID: 24806536»PubMed
  200. Kamel HK, Iqbal MA, Mogallapu R ym. Time to ambulation after hip fracture surgery: relation to hospitalization outcomes. J Gerontol A Biol Sci Med Sci 2003;58:1042-5 «PMID: 14630887»PubMed
  201. Oldmeadow LB, Edwards ER, Kimmel LA ym. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg 2006;76:607-11 «PMID: 16813627»PubMed
  202. Hoenig H, Rubenstein LV, Sloane R ym. What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture? Arch Intern Med 1997;157:513-20 «PMID: 9066455»PubMed
  203. Kimmel LA, Liew SM, Sayer JM ym. HIP4Hips (High Intensity Physiotherapy for Hip fractures in the acute hospital setting): a randomised controlled trial. Med J Aust 2016;205:73-8 «PMID: 27456448»PubMed
  204. Huusko TM, Karppi P, Avikainen V ym. Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ 2000;321:1107-11 «PMID: 11061730»PubMed
  205. Moseley AM, Sherrington C, Lord SR ym. Mobility training after hip fracture: a randomised controlled trial. Age Ageing 2009;38:74-80 «PMID: 19017676»PubMed
  206. Allen J, Koziak A, Buddingh S ym. Rehabilitation in patients with dementia following hip fracture: a systematic review. Physiother Can 2012;64:190-201 «PMID: 23449813»PubMed
  207. Laurila J. [Delirium]. Duodecim 2012;128:642-7 «PMID: 22506327»PubMed
  208. American Geriatrics Society Expert Panel on Postoperative Delirium in Older A. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg 2015;220(2):136-48 e1
  209. Juliebø V, Bjøro K, Krogseth M ym. Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc 2009;57:1354-61 «PMID: 19573218»PubMed
  210. Bruce AJ, Ritchie CW, Blizard R ym. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr 2007;19:197-214 «PMID: 16973101»PubMed
  211. Oh ES, Li M, Fafowora TM ym. Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review. Int J Geriatr Psychiatry 2015;30:900-10 «PMID: 25503071»PubMed
  212. Marcantonio E, Ta T, Duthie E ym. Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. J Am Geriatr Soc 2002;50:850-7 «PMID: 12028171»PubMed
  213. Albrecht JS, Marcantonio ER, Roffey DM ym. Stability of postoperative delirium psychomotor subtypes in individuals with hip fracture. J Am Geriatr Soc 2015;63:970-6 «PMID: 25943948»PubMed
  214. Olofsson B, Stenvall M, Lundström M ym. Malnutrition in hip fracture patients: an intervention study. J Clin Nurs 2007;16:2027-38 «PMID: 17419798»PubMed
  215. Sieber FE, Mears S, Lee H ym. Postoperative opioid consumption and its relationship to cognitive function in older adults with hip fracture. J Am Geriatr Soc 2011;59:2256-62 «PMID: 22092232»PubMed
  216. Marcantonio ER, Flacker JM, Wright RJ ym. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001;49:516-22 «PMID: 11380742»PubMed
  217. Deschodt M, Braes T, Flamaing J ym. Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc 2012;60:733-9 «PMID: 22429099»PubMed
  218. de Jonghe A, van Munster BC, Goslings JC ym. Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial. CMAJ 2014;186:E547-56 «PMID: 25183726»PubMed
  219. Marcantonio ER, Palihnich K, Appleton P ym. Pilot randomized trial of donepezil hydrochloride for delirium after hip fracture. J Am Geriatr Soc 2011;59 Suppl 2:S282-8 «PMID: 22091574»PubMed
  220. Kalisvaart KJ, de Jonghe JF, Bogaards MJ ym. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc 2005;53:1658-66 «PMID: 16181163»PubMed
  221. Vochteloo AJ, Moerman S, van der Burg BL ym. Delirium risk screening and haloperidol prophylaxis program in hip fracture patients is a helpful tool in identifying high-risk patients, but does not reduce the incidence of delirium. BMC Geriatr 2011;11:39 «PMID: 21834991»PubMed
  222. Lonergan E, Britton AM, Luxenberg J ym. Antipsychotics for delirium. Cochrane Database Syst Rev 2007;2:CD005594 «PMID: 17443602»PubMed
  223. Lonergan E, Luxenberg J, Areosa Sastre A. Benzodiazepines for delirium. Cochrane Database Syst Rev 2009;4:CD006379 «PMID: 19821364»PubMed
  224. Bourne RS, Tahir TA, Borthwick M ym. Drug treatment of delirium: past, present and future. J Psychosom Res 2008;65:273-82 «PMID: 18707951»PubMed
  225. Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med 2010;3:1-17 «PMID: 20463818»PubMed
  226. Nuotio M, Tuominen P, Luukkaala T. Association of nutritional status as measured by the Mini-Nutritional Assessment Short Form with changes in mobility, institutionalization and death after hip fracture. Eur J Clin Nutr 2016;70:393-8 «PMID: 26486304»PubMed
  227. Puskarich CL, Nelson CL, Nusbickel FR ym. The use of two nutritional indicators in identifying long bone fracture patients who do and do not develop infections. J Orthop Res 1990;8:799-803 «PMID: 2213336»PubMed
  228. Patterson BM, Cornell CN, Carbone B ym. Protein depletion and metabolic stress in elderly patients who have a fracture of the hip. J Bone Joint Surg Am 1992;74:251-60 «PMID: 1541619»PubMed
  229. Ponzer S, Tidermark J, Brismar K ym. Nutritional status, insulin-like growth factor-1 and quality of life in elderly women with hip fractures. Clin Nutr 1999;18:241-6 «PMID: 10578024»PubMed
  230. Bell JJ, Pulle RC, Crouch AM ym. Impact of malnutrition on 12-month mortality following acute hip fracture. ANZ J Surg 2016;86:157-61 «PMID: 26748473»PubMed
  231. Bell JJ, Bauer JD, Capra S ym. Multidisciplinary, multi-modal nutritional care in acute hip fracture inpatients - results of a pragmatic intervention. Clin Nutr 2014;33:1101-7 «PMID: 24388594»PubMed
  232. Klotzbuecher CM, Ross PD, Landsman PB ym. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000;15:721-39 «PMID: 10780864»PubMed
  233. Lyles KW, Schenck AP, Colón-Emeric CS. Hip and other osteoporotic fractures increase the risk of subsequent fractures in nursing home residents. Osteoporos Int 2008;19:1225-33 «PMID: 18301857»PubMed
  234. Stenvall M, Olofsson B, Lundström M ym. Inpatient falls and injuries in older patients treated for femoral neck fracture. Arch Gerontol Geriatr 2006;43:389-99 «PMID: 16540190»PubMed
  235. Stenvall M, Olofsson B, Lundström M ym. A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int 2007;18:167-75 «PMID: 17061151»PubMed
  236. Kaukonen JP, Lüthje P, Nurmi-Lüthje I ym. Second hip fracture and patients' medication after the first hip fracture: a follow-up of 221 hip fracture patients in Finland. Arch Gerontol Geriatr 2011;52:185-9 «PMID: 20399516»PubMed
  237. Ryg J, Rejnmark L, Overgaard S ym. Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977-2001. J Bone Miner Res 2009;24:1299-307 «PMID: 19257816»PubMed
  238. Zhu Y, Chen W, Sun T ym. Meta-analysis of risk factors for the second hip fracture (SHF) in elderly patients. Arch Gerontol Geriatr 2014;59:1-6 «PMID: 24657007»PubMed
  239. Korpi M, Luukkala T, Jäntti P, ym. Lonkkamurtumapotilaiden arviointi geriatrian poliklinikalla. Suomen Lääkäril 2013;68:131-8
  240. Avenell A, Mak JC, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev 2014;4:CD000227 «PMID: 24729336»PubMed
  241. Bolland MJ, Leung W, Tai V ym. Calcium intake and risk of fracture: systematic review. BMJ 2015;351:h4580 «PMID: 26420387»PubMed
  242. Fox KM, Magaziner J, Hawkes WG ym. Loss of bone density and lean body mass after hip fracture. Osteoporos Int 2000;11:31-5 «PMID: 10663356»PubMed
  243. Prestmo A, Hagen G, Sletvold O ym. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet 2015;385:1623-33 «PMID: 25662415»PubMed
  244. Young J. Rehabilitation and older people. BMJ (Clinical research ed.) 1996;313(7058):677-81
  245. Stenvall M, Olofsson B, Nyberg L ym. Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. J Rehabil Med 2007;39:232-8 «PMID: 17468792»PubMed
  246. Berggren M, Stenvall M, Olofsson B ym. Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up. Osteoporos Int 2008;19:801-9 «PMID: 18030411»PubMed
  247. Crotty M, Unroe K, Cameron ID ym. Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people. Cochrane Database Syst Rev 2010;1:CD007624 «PMID: 20091644»PubMed
  248. Parker MJ, Pryor GA, Myles JW. Early discharge after hip fracture. Prospective 3-year study of 645 patients. Acta Orthop Scand 1991;62:563-6 «PMID: 1767649»PubMed
  249. O'Cathain A. Evaluation of a Hospital at Home scheme for the early discharge of patients with fractured neck of femur. J Public Health Med 1994;16:205-10 «PMID: 7946496»PubMed
  250. Crotty M, Whitehead CH, Gray S ym. Early discharge and home rehabilitation after hip fracture achieves functional improvements: a randomized controlled trial. Clin Rehabil 2002;16:406-13 «PMID: 12061475»PubMed
  251. Ghazipura M. Community versus inpatient rehabilitation in hip fracture patients: a rapid review. Toronto, Ontario2013.
  252. Huusko T. Hip fractures in Central Finland and geriatric rehabilitation after hip fracture operation. Kuopion yliopisto; 2001.
  253. Jónsson B, Sernbo I, Johnell O. Rehabilitation of hip fracture patients with Parkinson's Disease. Scand J Rehabil Med 1995;27:227-30 «PMID: 8650507»PubMed
  254. Bliemel C, Oberkircher L, Eschbach DA ym. Impact of Parkinson's disease on the acute care treatment and medium-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg 2015;135:1519-26 «PMID: 26253249»PubMed
  255. Critchley RJ, Khan SK, Yarnall AJ ym. Occurrence, management and outcomes of hip fractures in patients with Parkinson's disease. Br Med Bull 2015;115:135-42 «PMID: 26130734»PubMed
  256. Ramnemark A, Nilsson M, Borssén B ym. Stroke, a major and increasing risk factor for femoral neck fracture. Stroke 2000;31:1572-7 «PMID: 10884456»PubMed
  257. Huusko TM, Karppi P, Avikainen V ym. Intensive geriatric rehabilitation of hip fracture patients: a randomized, controlled trial. Acta Orthop Scand 2002;73:425-31 «PMID: 12358116»PubMed
  258. Mak JC, Cameron ID, March LM ym. Evidence-based guidelines for the management of hip fractures in older persons: an update. Med J Aust 2010;192:37-41 «PMID: 20047547»PubMed
  259. Salpakoski A, Törmäkangas T, Edgren J ym. Effects of a multicomponent home-based physical rehabilitation program on mobility recovery after hip fracture: a randomized controlled trial. J Am Med Dir Assoc 2014;15:361-8 «PMID: 24559642»PubMed
  260. Di Monaco M, Vallero F, De Toma E ym. A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: a quasi-randomized controlled trial. J Rehabil Med 2008;40:446-50 «PMID: 18509559»PubMed
  261. Chudyk AM, Jutai JW, Petrella RJ ym. Systematic review of hip fracture rehabilitation practices in the elderly. Arch Phys Med Rehabil 2009;90:246-62 «PMID: 19236978»PubMed
  262. Sherrington C, Tiedemann A, Cameron I. Physical exercise after hip fracture: an evidence overview. Eur J Phys Rehabil Med 2011;47:297-307 «PMID: 21555983»PubMed
  263. Auais MA, Eilayyan O, Mayo NE. Extended exercise rehabilitation after hip fracture improves patients' physical function: a systematic review and meta-analysis. Phys Ther 2012;92:1437-51 «PMID: 22822235»PubMed
  264. Diong J, Allen N, Sherrington C. Structured exercise improves mobility after hip fracture: a meta-analysis with meta-regression. Br J Sports Med 2016;50:346-55 «PMID: 26036676»PubMed
  265. Zidén L, Frändin K, Kreuter M. Home rehabilitation after hip fracture. A randomized controlled study on balance confidence, physical function and everyday activities. Clin Rehabil 2008;22:1019-33 «PMID: 19052241»PubMed
  266. Portegijs E, Kallinen M, Rantanen T ym. Effects of resistance training on lower-extremity impairments in older people with hip fracture. Arch Phys Med Rehabil 2008;89:1667-74 «PMID: 18760151»PubMed
  267. Edgren J, Rantanen T, Heinonen A ym. Effects of progressive resistance training on physical disability among older community-dwelling people with history of hip fracture. Aging Clin Exp Res 2012;24:171-5 «PMID: 22842835»PubMed
  268. Heinonen M, Karppi P, Huusko T ym. Post-operative degree of mobilization at two weeks predicts one-year mortality after hip fracture. Aging Clin Exp Res 2004;16:476-80 «PMID: 15739600»PubMed
  269. Hu F, Jiang C, Shen J ym. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012;43:676-85 «PMID: 21683355»PubMed
  270. Smith T, Pelpola K, Ball M ym. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014;43:464-71 «PMID: 24895018»PubMed
  271. Radinovic K, Markovic-Denic L, Dubljanin-Raspopovic E ym. Estimating the effect of incident delirium on short-term outcomes in aged hip fracture patients through propensity score analysis. Geriatr Gerontol Int 2015;15:848-55 «PMID: 25258087»PubMed
  272. Zywiel MG, Hurley RT, Perruccio AV ym. Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture. J Bone Joint Surg Am 2015;97:829-36 «PMID: 25995494»PubMed
  273. Krogseth M, Wyller TB, Engedal K ym. Delirium is a risk factor for institutionalization and functional decline in older hip fracture patients. J Psychosom Res 2014;76:68-74 «PMID: 24360144»PubMed
  274. Witlox J, Slor CJ, Jansen RW ym. The neuropsychological sequelae of delirium in elderly patients with hip fracture three months after hospital discharge. Int Psychogeriatr 2013;25:1521-31 «PMID: 23651760»PubMed
  275. Gjertsen JE, Baste V, Fevang JM ym. Quality of life following hip fractures: results from the Norwegian hip fracture register. BMC Musculoskelet Disord 2016;17:265 «PMID: 27387741»PubMed
  276. Häkkinen A, Heinonen M, Kautiainen H ym. Effect of cognitive impairment on basic activities of daily living in hip fracture patients: a 1-year follow-up. Aging Clin Exp Res 2007;19:139-44 «PMID: 17446725»PubMed
  277. Laulund AS, Lauritzen JB, Duus BR ym. Routine blood tests as predictors of mortality in hip fracture patients. Injury 2012;43:1014-20 «PMID: 22236368»PubMed
  278. Goisser S, Schrader E, Singler K ym. Malnutrition According to Mini Nutritional Assessment Is Associated With Severe Functional Impairment in Geriatric Patients Before and up to 6 Months After Hip Fracture. J Am Med Dir Assoc 2015;16:661-7 «PMID: 25864084»PubMed
  279. Bellelli G, Mazzola P, Morandi A ym. Duration of postoperative delirium is an independent predictor of 6-month mortality in older adults after hip fracture. J Am Geriatr Soc 2014;62:1335-40 «PMID: 24890941»PubMed
  280. Mazzola P, Bellelli G, Broggini V ym. Postoperative delirium and pre-fracture disability predict 6-month mortality among the oldest old hip fracture patients. Aging Clin Exp Res 2015;27:53-60 «PMID: 24880696»PubMed
  281. Anbar R, Beloosesky Y, Cohen J ym. Tight calorie control in geriatric patients following hip fracture decreases complications: a randomized, controlled study. Clin Nutr 2014;33:23-8 «PMID: 23642400»PubMed
  282. Avenell A, Gillespie WJ, Gillespie LD ym. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 2009;2:CD000227 «PMID: 19370554»PubMed
  283. Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev 2010;1:CD001880 «PMID: 20091525»PubMed
  284. Basques BA, Bohl DD, Golinvaux NS ym. General versus spinal anaesthesia for patients aged 70 years and older with a fracture of the hip. Bone Joint J 2015;97-B:689-95 «PMID: 25922465»PubMed
  285. Bischoff-Ferrari HA, Willett WC, Orav EJ ym. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 2012;367:40-9 «PMID: 22762317»PubMed
  286. Blomfeldt R, Törnkvist H, Eriksson K ym. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br 2007;89:160-5 «PMID: 17322427»PubMed
  287. Boldin C, Seibert FJ, Fankhauser F ym. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand 2003;74:53-8 «PMID: 12635794»PubMed
  288. Bretherton CP, Parker MJ. Early surgery for patients with a fracture of the hip decreases 30-day mortality. Bone Joint J 2015;97-B:104-8 «PMID: 25568422»PubMed
  289. Brown CH 4th, Azman AS, Gottschalk A ym. Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair. Anesth Analg 2014;118:977-80 «PMID: 24781567»PubMed
  290. Brox WT, Chan PH, Cafri G ym. Similar mortality with general or regional anesthesia in elderly hip fracture patients. Acta Orthop 2016;87:152-7 «PMID: 26986550»PubMed
  291. Capezuti E, Evans L, Strumpf N ym. Physical restraint use and falls in nursing home residents. J Am Geriatr Soc 1996;44:627-33 «PMID: 8642150»PubMed
  292. Capezuti E, Strumpf NE, Evans LK ym. The relationship between physical restraint removal and falls and injuries among nursing home residents. J Gerontol A Biol Sci Med Sci 1998;53:M47-52 «PMID: 9467433»PubMed
  293. Carlsson P, Tidermark J, Ponzer S ym. Food habits and appetite of elderly women at the time of a femoral neck fracture and after nutritional and anabolic support. J Hum Nutr Diet 2005;18:117-20 «PMID: 15788020»PubMed
  294. Chung M, Balk EM, Brendel M ym. Vitamin D and calcium: a systematic review of health outcomes. Evid Rep Technol Assess (Full Rep) 2009;1-420 «PMID: 20629479»PubMed
  295. Colais P, Di Martino M, Fusco D ym. The effect of early surgery after hip fracture on 1-year mortality. BMC Geriatr 2015;15:141 «PMID: 26510919»PubMed
  296. Colón-Emeric CS, Mesenbrink P, Lyles KW ym. Potential mediators of the mortality reduction with zoledronic acid after hip fracture. J Bone Miner Res 2010;25:91-7 «PMID: 19580467»PubMed
  297. Cranney A, Horsley T, O'Donnell S ym. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007;1-235 «PMID: 18088161»PubMed
  298. Deangelis JP, Ademi A, Staff I ym. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma 2012;26:135-40 «PMID: 22198652»PubMed
  299. DIPART (Vitamin D Individual Patient Analysis of Randomized Trials) Group. Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 2010;340:b5463 «PMID: 20068257»PubMed
  300. Dorr LD, Glousman R, Hoy AL ym. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplasty 1986;1:21-8 «PMID: 3559574»PubMed
  301. Ekström W, Karlsson-Thur C, Larsson S ym. Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate. J Orthop Trauma 2007;21:18-25 «PMID: 17211264»PubMed
  302. Eriksen EF, Lyles KW, Colón-Emeric CS ym. Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture. J Bone Miner Res 2009;24:1308-13 «PMID: 19257818»PubMed
  303. Farooqi V, van den Berg ME, Cameron ID ym. Anabolic steroids for rehabilitation after hip fracture in older people. Cochrane Database Syst Rev 2014;10:CD008887 «PMID: 25284341»PubMed
  304. French BG, Tornetta P 3rd. Use of an interlocked cephalomedullary nail for subtrochanteric fracture stabilization. Clin Orthop Relat Res 1998;95-100 «PMID: 9553539»PubMed
  305. Gruber-Baldini AL, Zimmerman S, Morrison RS ym. Cognitive impairment in hip fracture patients: timing of detection and longitudinal follow-up. J Am Geriatr Soc 2003;51:1227-36 «PMID: 12919234»PubMed
  306. Guay J, Parker MJ, Gajendragadkar PR ym. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev 2016;2:CD000521 «PMID: 26899415»PubMed
  307. Handoll HH, Cameron ID, Mak JC ym. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 2009;4:CD007125 «PMID: 19821396»PubMed
  308. Handoll HH, Sherrington C, Mak JC. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 2011;3:CD001704 «PMID: 21412873»PubMed
  309. Haynes RC, Pöll RG, Miles AW ym. An experimental study of the failure modes of the Gamma Locking Nail and AO Dynamic Hip Screw under static loading: a cadaveric study. Med Eng Phys 1997;19:446-53 «PMID: 9338885»PubMed
  310. Healey F, Oliver D, Milne A ym. The effect of bedrails on falls and injury: a systematic review of clinical studies. Age Ageing 2008;37:368-78 «PMID: 18495686»PubMed
  311. Hedbeck CJ, Enocson A, Lapidus G ym. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am 2011;93:445-50 «PMID: 21368076»PubMed
  312. Hedström M, Sjöberg K, Brosjö E ym. Positive effects of anabolic steroids, vitamin D and calcium on muscle mass, bone mineral density and clinical function after a hip fracture. A randomised study of 63 women. J Bone Joint Surg Br 2002;84:497-503 «PMID: 12043767»PubMed
  313. Inngul C, Blomfeldt R, Ponzer S ym. Cemented versus uncemented arthroplasty in patients with a displaced fracture of the femoral neck: a randomised controlled trial. Bone Joint J 2015;97-B:1475-80 «PMID: 26530648»PubMed
  314. Jensen J, Lundin-Olsson L, Nyberg L ym. Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial. Ann Intern Med 2002;136:733-41 «PMID: 12020141»PubMed
  315. Jensen J, Lundin-Olsson L, Nyberg L ym. Falls among frail older people in residential care. Scand J Public Health 2002;30:54-61 «PMID: 11928835»PubMed
  316. Joakimsen RM, Magnus JH, Fønnebø V. Physical activity and predisposition for hip fractures: a review. Osteoporos Int 1997;7:503-13 «PMID: 9604045»PubMed
  317. Järvinen TL, Michaëlsson K, Jokihaara J ym. Overdiagnosis of bone fragility in the quest to prevent hip fracture. BMJ 2015;350:h2088 «PMID: 26013536»PubMed
  318. Keating JF, Grant A, Masson M ym. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am 2006;88:249-60 «PMID: 16452734»PubMed
  319. Köpke S, Mühlhauser I, Gerlach A ym. Effect of a guideline-based multicomponent intervention on use of physical restraints in nursing homes: a randomized controlled trial. JAMA 2012;307:2177-84 «PMID: 22618925»PubMed
  320. Langslet E, Frihagen F, Opland V ym. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res 2014;472:1291-9 «PMID: 24081667»PubMed
  321. Liu M, Yang J, Yu X ym. The role of perioperative oral nutritional supplementation in elderly patients after hip surgery. Clin Interv Aging 2015;10:849-58 «PMID: 26005339»PubMed
  322. Lizaur-Utrilla A, Martinez-Mendez D, Collados-Maestre I ym. Early surgery within 2 days for hip fracture is not reliable as healthcare quality indicator. Injury 2016;47:1530-5 «PMID: 27168082»PubMed
  323. Lundström M, Olofsson B, Stenvall M ym. Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging Clin Exp Res 2007;19:178-86 «PMID: 17607084»PubMed
  324. Lunsjö K, Ceder L, Tidermark J ym. Extramedullary fixation of 107 subtrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus 3 other screw-plate systems. Acta Orthop Scand 1999;70:459-66 «PMID: 10622478»PubMed
  325. Luo X, He S, Li Z ym. Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients. Arch Orthop Trauma Surg 2012;132:455-63 «PMID: 22160512»PubMed
  326. Lyles KW, Colón-Emeric CS, Magaziner JS ym. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007;357:1799-809 «PMID: 17878149»PubMed
  327. Macaulay W, Nellans KW, Garvin KL ym. Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr Award. J Arthroplasty 2008;23:2-8 «PMID: 18722297»PubMed
  328. Moayyeri A. The association between physical activity and osteoporotic fractures: a review of the evidence and implications for future research. Ann Epidemiol 2008;18:827-35 «PMID: 18809340»PubMed
  329. Mouzopoulos G, Stamatakos M, Arabatzi H ym. The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options. Int Orthop 2008;32:367-73 «PMID: 17431621»PubMed
  330. Myint MW, Wu J, Wong E ym. Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. Age Ageing 2013;42:39-45 «PMID: 22685164»PubMed
  331. Nyholm AM, Palm H, Malchau H ym. Lacking evidence for performance of implants used for proximal femoral fractures - A systematic review. Injury 2016;47:586-94 «PMID: 26803696»PubMed
  332. Orosz GM, Magaziner J, Hannan EL ym. Association of timing of surgery for hip fracture and patient outcomes. JAMA 2004;291:1738-43 «PMID: 15082701»PubMed
  333. Parker MJ, Dutta BK, Sivaji C ym. Subtrochanteric fractures of the femur. Injury 1997;28:91-5 «PMID: 9205572»PubMed
  334. Parker MJ, Griffiths R. General versus regional anaesthesia for hip fractures. A pilot randomised controlled trial of 322 patients. Injury 2015;46:1562-6 «PMID: 26049662»PubMed
  335. Prieto-Alhambra D, Judge A, Arden NK ym. Fracture prevention in patients with cognitive impairment presenting with a hip fracture: secondary analysis of data from the HORIZON Recurrent Fracture Trial. Osteoporos Int 2014;25:77-83 «PMID: 23812596»PubMed
  336. Pripp AH, Dahl OE. The population attributable risk of nutrition and lifestyle on hip fractures. Hip Int 2015;25:277-81 «PMID: 25907388»PubMed
  337. Queally JM, Harris E, Handoll HH ym. Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database Syst Rev 2014;9:CD004961 «PMID: 25212485»PubMed
  338. Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthop 2006;77:359-67 «PMID: 16819672»PubMed
  339. Ryan DJ, Yoshihara H, Yoneoka D ym. Delay in Hip Fracture Surgery: An Analysis of Patient-Specific and Hospital-Specific Risk Factors. J Orthop Trauma 2015;29:343-8 «PMID: 25714442»PubMed
  340. Sanders KM, Stuart AL, Williamson EJ ym. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010;303:1815-22 «PMID: 20460620»PubMed
  341. Seitz DP, Gill SS, Bell CM ym. Postoperative medical complications associated with anesthesia in older adults with dementia. J Am Geriatr Soc 2014;62:2102-9 «PMID: 25370019»PubMed
  342. Shyu YI, Tsai WC, Chen MC ym. Two-year effects of an interdisciplinary intervention on recovery following hip fracture in older Taiwanese with cognitive impairment. Int J Geriatr Psychiatry 2012;27:529-38 «PMID: 21732418»PubMed
  343. Sieber FE, Zakriya KJ, Gottschalk A ym. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc 2010;85:18-26 «PMID: 20042557»PubMed
  344. Sihvonen SE, Sipilä S, Era PA. Changes in postural balance in frail elderly women during a 4-week visual feedback training: a randomized controlled trial. Gerontology 2004;50:87-95 «PMID: 14963375»PubMed
  345. Sloan JP, Wing P, Dian L ym. A pilot study of anabolic steroids in elderly patients with hip fractures. J Am Geriatr Soc 1992;40:1105-11 «PMID: 1401694»PubMed
  346. Smith TO, Hameed YA, Cross JL ym. Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery. Cochrane Database Syst Rev 2015;6:CD010569 «PMID: 26074478»PubMed
  347. Stenvall M, Berggren M, Lundström M ym. A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia--subgroup analyses of a randomized controlled trial. Arch Gerontol Geriatr 2012;54:e284-9 «PMID: 21930310»PubMed
  348. Taraldsen K, Thingstad P, Sletvold O ym. The long-term effect of being treated in a geriatric ward compared to an orthopaedic ward on six measures of free-living physical behavior 4 and 12 months after a hip fracture - a randomised controlled trial. BMC Geriatr 2015;15:160 «PMID: 26637222»PubMed
  349. Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am 2012;94:577-83 «PMID: 22488613»PubMed
  350. Tengstrand B, Cederholm T, Söderqvist A ym. Effects of protein-rich supplementation and nandrolone on bone tissue after a hip fracture. Clin Nutr 2007;26:460-5 «PMID: 17498850»PubMed
  351. Tidermark J, Ponzer S, Carlsson P ym. Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures. Clin Nutr 2004;23:587-96 «PMID: 15297095»PubMed
  352. Tinetti ME, Liu WL, Ginter SF. Mechanical restraint use and fall-related injuries among residents of skilled nursing facilities. Ann Intern Med 1992;116:369-74 «PMID: 1736769»PubMed
  353. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 2003;326:469 «PMID: 12609940»PubMed
  354. Tuunainen E, Jäntti P, Pyykko I ym. Intervention to prevent falls in elderly adults living in a residential home. J Am Geriatr Soc 2013;61:1426-7 «PMID: 23937499»PubMed
  355. Uzoigwe CE, Burnand HG, Cheesman CL ym. Early and ultra-early surgery in hip fracture patients improves survival. Injury 2013;44:726-9 «PMID: 23010072»PubMed
  356. van den Bekerom MP, Hilverdink EF, Sierevelt IN ym. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg Br 2010;92:1422-8 «PMID: 20884982»PubMed
  357. Watne LO, Torbergsen AC, Conroy S ym. The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial). BMC Med 2014;12:63 «PMID: 24735588»PubMed
  358. Vestergaard P, Mosekilde L, Langdahl B. Fracture prevention in postmenopausal women. BMJ Clin Evid 2011;2011: «PMID: 21542947»PubMed
  359. White SM, Moppett IK, Griffiths R ym. Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2). Anaesthesia 2016;71:506-14 «PMID: 26940645»PubMed
  360. White SM, Moppett IK, Griffiths R. Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset. Anaesthesia 2014;69:224-30 «PMID: 24428375»PubMed
  361. Vlaeyen E, Coussement J, Leysens G ym. Characteristics and effectiveness of fall prevention programs in nursing homes: a systematic review and meta-analysis of randomized controlled trials. J Am Geriatr Soc 2015;63:211-21 «PMID: 25641225»PubMed
  362. Zi-Sheng A, You-Shui G, Zhi-Zhen J ym. Hemiarthroplasty vs primary total hip arthroplasty for displaced fractures of the femoral neck in the elderly: a meta-analysis. J Arthroplasty 2012;27:583-90 «PMID: 21924582»PubMed
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