Orthopaedic patients undergoing emergency orthopaedic surgery should be
referred for cardiac evaluation only when they are symptomatic or when a
specific cardiac intervention is expected to reduce the surgical risk. A
preoperative delay of 24-48 h of emergency orthopaedic operations has
been associated with increased mortality and poor functional status of
the patients. Research in the preoperative setting is almost exclusively
retrospective because randomized studies are difficult to be performed
and pose serious ethical concerns. Moreover, inevitably, guidelines have
a low level of evidence and do not always provide a straightforward
framework for the preoperative care of the patients. This editorial
revisits the most common clinical cardiology dilemmas for emergency
orthopaedic surgery to explore controversies of current recommendations
and elaborate on the role of echocardiography in the perioperative
period in emergency orthopaedic surgery