Hip fracture
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Hip Fracture. Dr Janet Lippett Consultant Orthogeriatrician October 2011. Overview. Facts and Figures Hip Fracture – The Royal Berkshire Way Orthogeriatrics Pre-operative Assessment Falls Assessment Osteoporosis Assessment Post operative Care and Rehabilitation. Facts and Figures.

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Hip fracture

Hip Fracture

Dr Janet Lippett

Consultant Orthogeriatrician

October 2011


Overview

Overview

  • Facts and Figures

  • Hip Fracture – The Royal Berkshire Way

  • Orthogeriatrics

  • Pre-operative Assessment

  • Falls Assessment

  • Osteoporosis Assessment

  • Post operative Care and Rehabilitation


Facts and figures

Facts and Figures

  • 90% of patients admitted with a hip fracture are over 65.

  • 10% die in the first 30 days; 30% die within a year.

  • Its common – average 450/yr in the RBH.

  • <50% return back to their own home.

  • 80% of older women say they would rather die than experience the loss of independence and QOL associated with a hip fracture.

  • Fragility Fractures cost the UK health economy £1.8 billion a year

  • More bed days than stroke and heart disease


Hip fracture the royal berkshire way

Hip Fracture – The Royal Berkshire Way

  • Pre 2007 liaison service

  • New Orthogeriatric Service set up in 2007

    • Full time Consultant Orthogeriatrician

  • Achieving high standards in National Audits

    • Top 10 in 2010 National Hip Fracture Database Annual Report

    • Reduction in length of stay from 42 to 17 days

    • Nearly 100% falls and bone health assessments

    • Reduction in pressure sores


Orthogeriatrics

Orthogeriatrics

  • Pre-op assessment/optimisation, peri-operative complications, rehabilitation, falls and bone health assessments.

  • A good service reduces mortality, complications, length of stay and improves functional outcomes such as mobility and return to independence.

  • 1940s Lionel Cosin – rehabilitation of neck of femur fracture patients

  • 1950s Michael Devas and Bobby Irvine

  • 2000s Janet Lippett and Apu Chatterjee


Pre operative assessment

Pre-operative Assessment

  • Orthogeriatric medical assessment

  • Aim to get to theatre within 36 hours


Falls assessment

Falls Assessment

  • History

  • Medication Review

  • Gait and Balance

  • Home Hazard Assessment

  • Multidisciplinary Involvement

    • Occupational Therapist and Physiotherapy

  • NHFD results 2011 – 99% of patients assessed


Osteoporosis

Osteoporosis

  • Commonest bone disease in adults

  • Reduction in bone density with a subsequent increased risk of fracture.

  • Life time risk of fracture in women over 50 is 1 in 2.

  • Falls and fractures account for more inpatient bed days than stroke and cardiovascular disease.

  • Osteoporosis is a “silent illness”.

  • NHFD 2011 – 98% of patients assessed (cf 45% in 2007)


Risk factors

Gender

F>M

Parental history of hip fracture

Previous fracture

2-5 fold increased risk

Low BMI

Esp. if <20 kg/m2

Low Bone Mineral Density (BMD)

Smoking

Dose dependent

Alcohol

Esp. >3 units/day

Drugs

Steroids, anticonvulsants, heparin, hormone treatments for cancer

Risk Factors


What can we do guidelines

What can we do - guidelines

  • NICE guidance

    • Treat over 75s without investigation

  • FRAX and NOGG

    • DEXA vs lifestyle vs treat

  • National Osteoporosis Society

    • Usual guidance on the internet and has a local group


Dexa scanning

DEXA scanning


Lifestyle

Lifestyle

  • Exercise

    • Weightbearing – dancing, walking, aerobics

  • Diet

    • Fruit and veg, fish, dairy products

  • Sunlight

    • 10-20 mins exposure on base arms a day

  • Alcohol

    • Reduce intake to <3 units per day


Drug treatment

Drug Treatment

  • Calcium and Vitamin D for all

  • Bisphosphonates

    • Mainstay of treatment – Alendronate

    • Main side effect is indigestion

    • Must sit up for 30 mins after, drink with whole glass of water and avoid food

  • Strontium

    • Daily but doesn’t have complicated administration instructions

    • Main side effect is diarrhoea


Post operative care and rehabilitation

Post-operative Care and Rehabilitation

  • Post-operative complications

  • Tailor made rehabilitation programme

  • Woodley Ward

  • Community Rehabilitation

  • Inpatient Community Rehabilitation

  • National Hip Fracture Database


The future

The Future

  • Fracture Liaison Service

    • Improved service for femur fractures

    • Service for non hip fractures

    • Improved compliance with medication

    • Support for patients


Thanks

Thanks

  • Apu Chatterjee

  • Andrew McAndrew and the Orthopaedic Surgeons

  • Karen Barnard – Trauma Nurse Practioner

  • Helen Slade and Helen Mallock – Ward Managers

  • Liz Scott and the Physio team

  • Moyra Pugh and the OT team


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