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MSK block > Elderly Fall > Flashcards

Elderly Fall Flashcards

1
Q
A
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2
Q

What 3 bones comprise the hip and where are these fused?

A

Ilium, ischium and pubis → fused at the acetabulum

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3
Q

The acetabulum is deepened by a fibrocartilaginous ring call the ________ and an ________ ligament, which helps may the hip joint a very congruous joint

A

Acetabular labrum, inferior acetabular

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4
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5
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6
Q

List 3 examination findings of a NOF#

A
  1. leg shortened and externally rotated
  2. tenderness in groin and across the lateral hip (on the same side as #)
  3. pain on all attempted movement of the affected leg
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7
Q

On examination of a suspected NOF, what else must we check?

What would you expect the above to be?

A
  1. Sensation
  2. Pulses
  3. Power - on dorsiflection, knee flexion and extension

All normal

Also a full CVS, resp, GI and NV exam should be completed

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8
Q

DDX for NOF#

A
  1. Fractured NOF
  2. Pelvic fracture
  3. Acetabular fracture
  4. Femur fracture
  5. Pathological fracture
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9
Q

What does SBAR stand for?

A

Situation, background, assessment, recommendation

A format to summarise findings

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10
Q

List 4 investigations you would do for a NOF# and why

A
  1. X-ray: to view the area of interest
  2. ECG: cardiac abnormalities which may have caused the fall
  3. CRP - evidence of infection
  4. FBC – anaemia as possible cause of fall
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11
Q

List 3 sets of imaging we may do for a NOF#

A
  1. X-ray pelvis – to include both hips
  2. Affected hip x-ray, AP and lateral views
  3. CT/MRI of the hip if any uncertainty
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12
Q

What classification systems exists for intracapsular NOF#

Explain this classification

A

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
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13
Q

Identify the blood supply to the femoral head

A
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14
Q

What is indicated by the yellow line and what is the clinical relevance?

A

Shentons line

Help identify abnormalities at the hip joint, it should be a smooth line as seen on the imagine

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15
Q

List the 3 steps in management of a NOF# in the elderly

A
  1. Medication
  2. Referral and MDT approach
  3. Surgery
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16
Q

Medications used for management of a NOF#

A
  1. Analgesia (pain ladder), iliofascial block
  2. IV fluids (b/c NBM for theatre)
  3. VTE prophylais (b/c immobile and undergoing lower limb surgery)
17
Q

What is the MDT approach for management of a NOF#

A
  1. Refer to orthopaedics
  2. Anaesthetic review prior to surgery
  3. Physio and OT after surgery
  4. Nursing care including wound care
18
Q

Which surgical management is advised for the following fractures:

  1. Displaced subcapital
  2. Inter-trochanteric and Basocervical
  3. Non-displaced intra-capsular
  4. Sub-trochanteric
A
19
Q

Best practice aims for theatre with in _______ hours of admission, or diagnosis if already an inpatient (due to high mortality)

A

36

20
Q

What score is used to assess risk of fragility fractures?

To what age group of men and women is this reccomended for?

A

FRAX score

  • All women 65 +
  • All men 75 +
21
Q

What investigation is used to assess bone mineral density?

How is it scored/ catagorised?

A

Dexa scan (Dual energy xray absorptiometry)

Measures bone density and gives a score based on the SD from the normal young adult

22
Q

What conservative management would you consider to help manage a patient with osetoporosis?

A
  1. Good diet - adequate dietary calcium and Vit D
  2. Reduce alcohol intake
  3. Stop smoking
  4. Regular weight bearing exercise
  5. Avoid falls, use mobility aids, ensure floors are clear or trip hazards
23
Q

What medical management would you consider for the management of a patient with osteoporosis?

A
  1. Calcium and Vit D supplements (if indicated)
  2. Bisphosphonates eg. alendronic acid (prevent bone resorption)
24
Q

State the following regarding bisphosphonates

  1. Advise for patient
  2. Risks
A
  1. Taken once weekly on an empty stomach, patient needs to sit upright for 30 minutes after
  2. Risk of GI irritation, gastritis and bleeding

MSK block (30 decks)

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