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Table 3 The big five in management of geriatric patients with femoral neck fractures (compiled from the AO-guidelines)

From: Management of proximal femur fractures in the elderly: current concepts and treatment options

The big five in management of a geriatric patient with a femoral fracture to avoid the most common complications
Time to surgery The less time passes from admission to surgery, the fewer complications
Pain management Pain management can be accomplished by a stable fixation, paracetamol, oral or parenteral opioids and regional nerve blockades
Delirium prevention Prevention is the best strategy concerning delirium. Thorough fluid management (pre and postoperatively), help with orientation, avoiding of tethers such as tubes (urine catheter removal on the second day postoperatively if possible), help with orientation like for example hearing aids, proper pain management and hydration management contribute to lower the incidences of delirium
Early mobilisation Physiotherapy and respiratory therapy prevent pneumonia and thrombotic events. Anticoagulation is needed for 28–35 days
Patient care A proper postoperative bowel regimen prevents obstipation, pressure soars can be avoided by early surgery and frequent repositioning