How should I approach the management of fractures in patients with comorbidities or those on anticoagulant therapy?

When managing fractures in patients with comorbidities or those on anticoagulant therapy, a comprehensive and individualised approach is crucial to ensure timely and effective care.

• For patients with hip fractures, it is essential to identify and treat correctable comorbidities immediately to prevent delays in surgery ². These include, but are not limited to, anaemia, volume depletion, electrolyte imbalance, uncontrolled diabetes, uncontrolled heart failure, correctable cardiac arrhythmia or ischaemia, acute chest infection, and exacerbation of chronic chest conditions ².
• Documentation of comorbidities should be considered from the patient's first presentation ¹.
• Recognise that current disease-oriented guidelines may not fully account for the interactions between multiple conditions, and an individualised management plan should be developed and agreed upon with the patient ⁵. This plan should outline goals, future care, medication adjustments, prioritisation of appointments, and anticipation of health changes ⁵.
• For patients at risk of fragility fractures, such as those with osteoporosis, assess for vitamin D deficiency and inadequate calcium intake, and identify risk factors for falls ³. Oral bisphosphonates may be offered, especially if there is a prior fragility fracture or other risk factors, with specialist referral considered if oral bisphosphonates are not tolerated or are contraindicated ³.

• Anticoagulation is a correctable comorbidity that should be addressed immediately to avoid delaying surgery, particularly for hip fractures ².
• The perioperative management of proximal femoral fractures in the elderly, especially concerning antiplatelet and anticoagulant therapy, is a significant area of clinical focus (Merloz, 2018; Malliou et al., 2023; Šteňo et al., 2024).
• Patients on anticoagulant therapy should be informed about potential adverse effects, drug interactions, and the importance of carrying an 'anticoagulant alert card' ⁶.

• Provide patients with both verbal and written information about their management plan, including expected outcomes, activities to aid recovery, home care options, and rehabilitation details ¹.
• Ensure all healthcare professionals have access to previously given information to maintain consistency ¹.