How Late Is Too Late? The Slow Fracture in Our Hip-Fracture Timelines

Abstract

The question of how quickly a hip fracture should be fixed and whether antithrombotic therapy should delay it remains one of the more contested areas of perioperative practice, and one where anaesthetists sit at the centre of the decision. Hip fractures in older adults represent one of the most formidable clinical and societal challenges in modern healthcare. With global projections indicating a staggering rise from 2.2 million cases in 2017 to 4.5 million by 2050, these injuries are far more than orthopaedic emergencies — they are life-altering events for a frail, elderly demographic. Typically burdened with multiple medical comorbidities and polypharmacy, over half of these patients fall into ASA physical status 3 or 4. I write to summarise where the current evidence and major society guidance stand, and to highlight the lacunae that continue to make this a genuinely difficult bedside judgement rather than a solved problem.