Аңдатпа
Hip fracture in older adults is not only an orthopedic event but also a major systemic stressor. In frail geriatric patients, postoperative deterioration, intensive care unit (ICU) admission, and organ dysfunction are associated with high mortality and poor functional recovery. Because phosphocreatine is a central component of intracellular energy buffering, it has been proposed as a potential adjunctive metabolic therapy under conditions of bioenergetic failure.Objective.To critically review the biological rationale and the available clinical evidence for phosphocreatine-based metabolic support in older adults with hip fracture complicated by critical illness or organ dysfunction.Methods.This narrative review was based on a structured literature search of PubMed, Scopus, and Web of Science from January 2000 to January 2026. The search prioritized direct clinical studies in geriatric hip fracture populations and, when such studies were absent, the closest indirect clinical evidence from perioperative and critical care settings. The review focused primarily on exogenous phosphocreatine or sodium phosphocreatine; oral creatine supplementation studies were considered only for contextual safety or mechanistic discussion, not as direct therapeutic evidence.Results.No interventional clinical studies directly evaluating phosphocreatine in geriatric hip fracture patients with organ dysfunction or critical illness were identified. The available evidence is indirect and derives mainly from cardiac surgery, septic shock, and perioperative anesthesia settings. Randomized studies suggest that phosphocreatine is feasible and appears to have an acceptable short-term safety profile, but they do not demonstrate consistent improvements in clinically important outcomes such as Sequential Organ Failure Assessment (SOFA) score, ICU stay, or mortality. Observational studies in septic shock report possible improvements in cardiac function and short-term survival, but these findings are limited by indirectness, confounding, and heterogeneity. Functional outcomes central to hip fracture care pathways, including mobility recovery, discharge destination, and return to independence, have not been evaluated. Conclusions.Current evidence is insufficient to support routine phosphocreatine-based metabolic therapy in geriatric hip fracture patients with critical illness or organ dysfunction. The biological rationale is plausible, but direct clinical validation is lacking. Future trials should target high-risk hip fracture populations and evaluate organ dysfunction trajectories, mortality, renal safety, and patient-centered functional outcomes.