Clinical practice guideline recommendations for orthopedic surgical management of traumatic hip fractures: a systematic review

Purpose: Hip fractures pose a critical orthopedic challenge, disproportionately affecting older adults and significantly compromising mobility and independence. The complexity of both the injury and the patient profile necessitates adopting best practices grounded in research evidence to optimize surgical management and recovery. This study comprehensively evaluated the quality and clinical applicability of existing clinical practice guidelines (CPGs) for the orthopedic surgical management of traumatic hip fractures and summarized key practice recommendations. Methods: A systematic literature search was performed across five databases (PubMed, CINAHL, Scopus, Embase, and PEDro) for CPGs published since January 2000. Two reviewers independently identified eligible CPGs using predefined criteria. The methodological quality of eligible CPGs was assessed using the AGREE II tool, which examines quality across the domains of scope, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. The complementary AGREE-REX tool was used to assess the guidelines' clinical relevance and applicability. Results: Six CPGs were critically appraised, and two demonstrated high methodological quality scores (2009 SIGN and 2023 NICE CPGs). Across all CPGs, there was consensus emphasizing surgical timing within 24 to 48 hours after a hip fracture. In addition, most CPGs recommended against the use of preoperative traction. Recommendations for diagnostic imaging were supported by limited high-quality evidence. Domains addressing target users' values and resource feasibility scored lowest across CPGs, diminishing implementability. Conclusions: Fewer than half of the appraised CPGs were rated high quality, and important clinical practice domains were insufficiently addressed. Orthopedic surgeons should follow recommendations to perform operative intervention within 24 to 48 hours after injury and avoid preoperative traction. The findings also underscore the need to develop CPGs with higher methodological rigor and more actionable practice recommendations.