Elderly Fall Flashcards
What 3 bones comprise the hip and where are these fused?
Ilium, ischium and pubis → fused at the acetabulum
The acetabulum is deepened by a fibrocartilaginous ring call the ________ and an ________ ligament, which helps may the hip joint a very congruous joint
Acetabular labrum, inferior acetabular
List 3 examination findings of a NOF#
- leg shortened and externally rotated
- tenderness in groin and across the lateral hip (on the same side as #)
- pain on all attempted movement of the affected leg
On examination of a suspected NOF, what else must we check?
What would you expect the above to be?
- Sensation
- Pulses
- Power - on dorsiflection, knee flexion and extension
All normal
Also a full CVS, resp, GI and NV exam should be completed
DDX for NOF#
- Fractured NOF
- Pelvic fracture
- Acetabular fracture
- Femur fracture
- Pathological fracture
What does SBAR stand for?
Situation, background, assessment, recommendation
A format to summarise findings
List 4 investigations you would do for a NOF# and why
- X-ray: to view the area of interest
- ECG: cardiac abnormalities which may have caused the fall
- CRP - evidence of infection
- FBC – anaemia as possible cause of fall
List 3 sets of imaging we may do for a NOF#
- X-ray pelvis – to include both hips
- Affected hip x-ray, AP and lateral views
- CT/MRI of the hip if any uncertainty
What classification systems exists for intracapsular NOF#
Explain this classification
Gardens Classification - based on appearance on plain AP x-ray
Type 1 and 2
- minimal disruption of blood supply
- can often be fixed with internal fixation and screws
Type 3-4 →
- displacement, more likely to compromise blood supply to head of the femur (risk of AVN)
- usually treated with a hemiarthoplasty
Identify the blood supply to the femoral head
What is indicated by the yellow line and what is the clinical relevance?
Shentons line
Help identify abnormalities at the hip joint, it should be a smooth line as seen on the imagine
List the 3 steps in management of a NOF# in the elderly
- Medication
- Referral and MDT approach
- Surgery
Medications used for management of a NOF#
- Analgesia (pain ladder), iliofascial block
- IV fluids (b/c NBM for theatre)
- VTE prophylais (b/c immobile and undergoing lower limb surgery)
What is the MDT approach for management of a NOF#
- Refer to orthopaedics
- Anaesthetic review prior to surgery
- Physio and OT after surgery
- Nursing care including wound care
Which surgical management is advised for the following fractures:
- Displaced subcapital
- Inter-trochanteric and Basocervical
- Non-displaced intra-capsular
- Sub-trochanteric
Best practice aims for theatre with in _______ hours of admission, or diagnosis if already an inpatient (due to high mortality)
36
What score is used to assess risk of fragility fractures?
To what age group of men and women is this reccomended for?
FRAX score
- All women 65 +
- All men 75 +
What investigation is used to assess bone mineral density?
How is it scored/ catagorised?
Dexa scan (Dual energy xray absorptiometry)
Measures bone density and gives a score based on the SD from the normal young adult
What conservative management would you consider to help manage a patient with osetoporosis?
- Good diet - adequate dietary calcium and Vit D
- Reduce alcohol intake
- Stop smoking
- Regular weight bearing exercise
- Avoid falls, use mobility aids, ensure floors are clear or trip hazards
What medical management would you consider for the management of a patient with osteoporosis?
- Calcium and Vit D supplements (if indicated)
- Bisphosphonates eg. alendronic acid (prevent bone resorption)
State the following regarding bisphosphonates
- Advise for patient
- Risks
- Taken once weekly on an empty stomach, patient needs to sit upright for 30 minutes after
- Risk of GI irritation, gastritis and bleeding
