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Hip Fracture

Hip Fracture

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Hip Fracture

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  1. Hip Fracture Dr Janet Lippett Consultant Orthogeriatrician October 2011

  2. Overview • Facts and Figures • Hip Fracture – The Royal Berkshire Way • Orthogeriatrics • Pre-operative Assessment • Falls Assessment • Osteoporosis Assessment • Post operative Care and Rehabilitation

  3. 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

  4. 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

  5. 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

  6. Pre-operative Assessment • Orthogeriatric medical assessment • Aim to get to theatre within 36 hours

  7. Falls Assessment • History • Medication Review • Gait and Balance • Home Hazard Assessment • Multidisciplinary Involvement • Occupational Therapist and Physiotherapy • NHFD results 2011 – 99% of patients assessed

  8. 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)

  9. 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

  10. 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

  11. DEXA scanning

  12. 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

  13. 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

  14. Post-operative Care and Rehabilitation • Post-operative complications • Tailor made rehabilitation programme • Woodley Ward • Community Rehabilitation • Inpatient Community Rehabilitation • National Hip Fracture Database

  15. The Future • Fracture Liaison Service • Improved service for femur fractures • Service for non hip fractures • Improved compliance with medication • Support for patients

  16. 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