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Hip Fracture

Discover the impact of hip fractures, the innovative orthogeriatric services provided at Royal Berkshire Hospital, and the importance of pre-operative assessments, falls prevention, osteoporosis care, and post-operative rehabilitation. Learn about key interventions and risk factors to improve patient outcomes and reduce mortality rates. Explore the future of fracture liaison services and enhanced support for femur fractures and non-hip fractures. Acknowledge the dedicated healthcare professionals contributing to this holistic care approach.

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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

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