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CSI > Case 6 - Falls Pre-reading > Flashcards

Case 6 - Falls Pre-reading Flashcards

1
Q

What makes someone more likely to have a fall?

A

Age due to natural ageing process

Long term health condition

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2
Q

What proportion of adults over 65 living at home will have a fall at least once a year?

A

1 in 3

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3
Q

Aside from clinical consequences what can a fall result in?

A

Loss of confidence
Become withdrawn
Loss of independence

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4
Q

What should you do if you fall?

A

Keep calm
Don’t get up too quickly
Roll on your hands and knees
Look for a stable piece of furniture e.g. chair or bed
Hold with both hands
Rest before carrying on with daily activities

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5
Q

What should you do if you are hurt and unable to get up?

A 
Call out for help
Bang on wall or floor
Use aid call button
Call 999 
Try to reach something warm e.g. blanket/dressing gown to keep over you particularly legs and feet
Keep as comfortable as possible
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6
Q

How often should you change your position if you have fallen?

A

Every half and hour roughly

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7
Q

Falls are the most common cause of injury related deaths in what population?

A

People over the age of 75

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8
Q

Why are older people more susceptible to falls?

A

Balance problems
Muscle weakness
Poor vision
Long term health conditions e.g. hear disease, dementia of hypotension
Can lead to dizziness and a brief loss of conciousness
Reduced bone mineral density
Bones deficient in elastic reserve

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9
Q

What factors make a fall more likely to happen?

A

Floors are wet e.g. bathroom or recently polished
Dim lighting
Not properly secured rugs or carpets
Person is reaching for storage areas
Person is going down the stairs
Person is rushing to go to the toilet
Carrying out maintenance work on a ladder

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10
Q

Why may falls in older people be particularly problematic?

A

Osteoporosis

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11
Q

What makes you more susceptible to osteoporosis?

A

Smoking
Excessive alcohol consumption
Steroid medication
Family history of hip fractures

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12
Q

Why are older women more at risk of osteoporosis?

A

Often associated with hormonal changes during menopause

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13
Q

Give examples of measures that can help prevent falls

A 
Using non-slip mats in the bathroom
Mopping up spills 
Ensuring good lighting 
Removing clutter 
Getting help moving or lifting heavy items
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14
Q

What can a GP do to reduce the risk of falls?

A

Simple balance checks

Review of medication for side effects that may increase risk

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15
Q

What might a GP recommend to reduce the risk of falls?

A 
Sight test
ECG 
Blood pressure check
Request a home hazard assessment 
Doing exercises to improve strength and balance
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16
Q

Define hip fracture

A

Bony injury of the proximal femur typically occurring in the elderly

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17
Q

How much do hip fractures cost the NHS a year?

A

£1 billion

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18
Q

What are the risk factors for hip fractures?

A 
Increasing age
Osteoporosis 
Low muscle mass
Steroids
Smoking
Excess alcohol intake
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19
Q

What is the mean age for hip fractures?

A

80

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20
Q

How many hip fractures are there a year in the UK?

A

65,000

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21
Q

How many times more common are hip fractures in women?

A

4x

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22
Q

What is the 1 year mortality for hip fractures?

A

40%

23
Q

What comprises the proximal femur?

A 
Head
Neck
Greater trochanter
Lesser trochanter
Shaft
24
Q

What is unique about the proximal femur?

A

Largest bone in the human body

25
Q

What is the inter-trochanteric line?

A

Line that lies of the anterior surface of the femoral neck running between trochanters
Demarcates the inferior attachments of the hip capsule

26
Q

Where the hip capsule attached?

A

Proximally to margins of acetabulum and transverse acetabular ligament

Distally to the inter-trochanteric line

Posteriorly to the bases of the trochanters and the femoral neck

27
Q

What does the hip capsule contain?

A

Reticular vessels

28
Q

What are the reticular vessels?

A

Main blood supply to the femoral head
Originates from the extra-capsular arterial ring
Supplied by the medial and lateral circumflex vessels

29
Q

What is the foveal artery?

A

Supplies the epiphysis with a small amount of blood during skeletal development

30
Q

What are the metaphyseal vessels?

A

After skeletal maturity the contribute blood to the femoral head

31
Q

How can hip fractures be classified?

A

intra- or extra- capsular

32
Q

What does intra-capsular mean?

A

Above the inter-trochanteric line

33
Q

What does extra-capsular mean?

A

Below the inter-trochanteric line

34
Q

What does the type of fracture determine?

A

Likelihood of disruption to the blood supply fo the femoral head
Intra = higher risk

35
Q

How are intra-capsular fractures sub-classified?

A

According to garden’s classification

Type I-IV

36
Q

What is type I?

A

Incomplete

Impacted in valgus

37
Q

What is type II?

A

Complete

Undisplaced

38
Q

What is type III?

A

Complete

Partially displaced

39
Q

What is type IV?

A

Complete

Completely displaced

40
Q

How might a hip fracture be caused in a younger person?

A

Trauma
Gait disturbance e.g. MS
Prolonger steroid use

41
Q

How are hip fractures diagnosed?

A

Radiologically

May be suspected clinically

42
Q

How do patients with hip fractures typically present?

A

Inability to bear weight
Pain in the affected side
Reduced range of movement
Bony tenderness

43
Q

What bedside investigations can be carried out?

A

Observations
Urine dip
ECG

44
Q

What bloods should be done?

A 
FBC
U&E
CRP
Clotting
Group & Save x2
45
Q

What imaging can be done?

A

CXR pre-op
Plain films
MRI/CT if plain films are inconclusive
Cardiac echo

46
Q

What should you observe on an X-ray?

A

Shenton’s line should be continuous and smooth

47
Q

What is shenton’s line?

A

Imaginary curved line drawn along the inferior border of the superior ramus
Along the inferomedial border of the proximal femur

48
Q

How are most hip fractures treated?

A

Surgically

49
Q

When might surgery not be an option?

A

Significant co-morbidities

50
Q

Rarely what conservative measures could be used?

A

Traction
Bed rest
Restricted mobilisation
Outcomes are often very poor

51
Q

What do NICE recommend?

A

Surgery to be performed on the day of or the day after admission
Aim to allow patients to fully weight bear in the immediate post-op period

52
Q

What surgery is recommended for displaced intra-capsular fracture gardens III/IV?

A

THR
Total hip replacement for fit patients

Hemi-arthoplasty for patients with significant comorbidity

53
Q

What surgery is recommended for minimally displaced intra-capsular fracture gardens I/II?

A

2-3 cannulated hip screws

54
Q

What surgery is recommended for extra-capsular fractures?

A

Dynamic hip screw: Promotes bone healing

Intramedullary nail

CSI (10 decks)

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