FALLS

Question 1

What are the main causes of falls

Answer 1

Imbalance, muscle weakness, vision loss, long term health conditions (HD, HT, dementia), environment (wet floors and dim lights)

Question 2

What are the 2 consequences of falls

Answer 2

Broken bones and withdrawal

Question 3

What are hip fractures

Answer 3

Bony injury of proximal Femur

Question 4

What are the 3 blood supplies to the head of the femur

Answer 4

1) major, retinacular vessels
2) minor fovea artery
3) metaphyseal vessels

Question 5

What is the difference between intra and extra capsular fractures

Answer 5

Intra - above inter trochanteric line
Extrac- below intertrochanteric line

Question 6

What is the garden’s type classification

Answer 6

• for intracapsular fractures
  1&2 = slightly displaced = less risk of blood supply disruption
  3&4 = more displaced = increase risk
• 2 onwards is complete fracture

Question 7

What are the risk factors of a hip fracture

Answer 7

• age
• osteoporosis
• low muscle mass
• steroids
• smoking
• alchohol
• metastatic spread of cancer to bone

Question 8

What are the signs and symptoms of hip fracture?

Answer 8

Symptoms:
- hip and knee pain
- inability to bear weight
- limited motion range
Signs:
- bony tenderness over affected hip
- shortened/externally rotated leg

Question 9

What imagining is required for investigation?

Answer 9

CXR, Plain films, MRI/CT, Cardiac echo

Question 10

What is shentons line

Answer 10

Shentons line is a curved line drawn from inferior border of superior ramus along the inferomedial border of the neck of the femur, it should be continuous.

Question 11

What are the steps of initial management?

Answer 11

• urine and blood routine investigations + catheter
• analgesia
• medication review
• pre op assessment

Question 12

What is the surgical management?

Answer 12

Intracapsular types 1&2 - cannulated hip screws
Intracapsular types 3&4 - THR or hemi-arthoplasty
Extracapsular - dynamic hip screws or intra-medullary nails.

Question 13

What things should be considered post-op

Answer 13

• daily reviews for chest and urinary infections
• increased risk of DVT ( prophylaxis dose LMWH)
• physiotherapy

Question 14

What are the risk factors of delirium?

Answer 14

acutely developing behavioural change such as:
- altered cognitive function
- inattention
- disorganised thinking
- altered perception
- altered physical function
- altered social behaviour
- altered consciousness

Question 15

What are the types of delirium?

Answer 15

Hyperactive - inappropriate behaviour, hallucinations and agitation.
Hypoactive- lethargy, reduced concentration and appetite.
Mixed - both types present

Question 16

What are some triggers for delirium?

Answer 16

• infection
• drugs (opioids, steroids, sedatives, new prescription)
• surgery
• heart failure or MI
• hypo/erthyroidism
• dehydration
• environment change

Question 17

What are the two key questions for a patient who has had a fall?

Answer 17

• why did they fall?
• what was the consequence of the fall?

Question 18

What are the three subtypes of intracapsular fractures?

Answer 18

(From most proximal to distal)
1) sub capital
2) midcervical
3) basicervical

Question 19

What are the 2 features of the demographic that have a higher risk of hip fractures

Answer 19

-65+
-Women

Question 20

Describe bone composition.

Answer 20

Mineral - 70-80%
Organic matrix - 20-30%
Water - 5-10%
Cells - 2%

Question 21

What are the cells found in bone

Answer 21

Osteoblasts- build, release collagen, secrete calcium and phosphate, maintain bone tissue)
Osteoclasts - release enzymes that break down collagen
Osteogenic cells - stem cells
Osteocytes - maintain bone tissue

Question 22

What is the bone modelling cascade?

Answer 22

1.Osteocytes sense microdamage
2. Osteocytes signal bone lining cells
3. Osteoclasts recruited
4. Osteoclast perform resorption
5. This attracts osteoblasts
6. Osteoblasts make new bone
7. Osteoblasts turn into osteocytes and bone lining cells.

Question 23

Why are women more likely to have hip fractures?

Answer 23

Menopause = ⬇️ Vit D and Ca+ = resportion>formation = osteoporosis

Question 24

Why are older people more prone to fractures?

Answer 24

• fewer and fewer osteogenic cells turn into osteoblasts
• decrease in bone density
  -less exposure to sim

Question 25

What is sarcopenia

Answer 25

Syndrome characterised by progressive and generalised loss of muscle mass
Correlated with physical disability, falls and low bone density.

Question 26

What is the mechanostat theory

Answer 26

Mechanostat theory is the theory that bone and muscle strength are linked.
⬆️ mechanical stimulus = ⬆️ bone formation.

Question 27

What drugs increase bone density? And how?

Answer 27

Bisphosphonates
- attracted to bone
- ingested by osteoclasts
- blocks enzyme in osteoclast that stops its function

Question 28

What are the contraindications of bisphosphonates?

Answer 28

• mainly GI, looks like phospholipids that line gut, gives passage for stomach acids

Question 29

What other drugs can be given to osteoporosis patients?

Answer 29

• supplements for VIT D and Ca2+
  -SERM for oestrogen

Question 30

What xray is used for bone density?

Answer 30

DEXA
Score of -1 to +1 is normal
Anything less than -1 is worrisome
Less than -2 is osteoporotic

Question 31

What is oestrodiol and what is it’s effect on osteoclast and osteoblasts cell function?

Answer 31

1) stimulates TGF beta actions on both C and B.
2) inhibits IL6, and T cell IL1 and TNF.
3) therefore in a oestrogen deficient state, osteoblasts have shorter survival and osteoclasts are more active and live longer

Question 32

What is RANK L and how do we take advantage of it to treat osteoporosis in people intolerant of bisphosphonates

Answer 32

1) most powerful stimulant of osteoclast activity
2) can be blocked by osteoprotegerin or denosumab