Management of hip fractures in the elderly: to fix or not to fix?

Hip fracture ( HF) is a frequent condition in the elderly population, especially females. It is associated with higher mortality, decreased functionality, higher dependency, and in general poorer quality of life (QoL) for the patients and caregivers. At present, there is no well -established evidence -based guideline regarding the ideal treatment approach for this condition. Most of the evidence suggests that surgical management is the optimal approach in most scenarios, providing the best outcomes, the highest survival rates, and the most improvement in QoL. However, other studies in specific subpopulations, like highly frail elder patients, or those with short life expectancy, indicate these subjects may not benefit as much from the procedure. Furthermore, most of the available information focuses on survival rates and other medical parameters, while ignoring other patient centered aspects like QoL, comfort, and treatment satisfaction. In general, it is recommended to perform a proper and individualized evaluation before deciding to operate. Proper candidate selection, taking into consideration comorbidities, life expectancy, patient preference, and overall benefits should lead, in most cases, toward the surgical approach. However, non -operative management should not be neglected when the conditions to operate are not met. This review aims to understand the fundamentals behind the decision making for total hip replacement in the elderly, and to ponder the potential approaches after considering several risk and protective factors.