FALLS Flashcards
What are the main causes of falls
Imbalance, muscle weakness, vision loss, long term health conditions (HD, HT, dementia), environment (wet floors and dim lights)
What are the 2 consequences of falls
Broken bones and withdrawal
What are hip fractures
Bony injury of proximal Femur
What are the 3 blood supplies to the head of the femur
1) major, retinacular vessels
2) minor fovea artery
3) metaphyseal vessels
What is the difference between intra and extra capsular fractures
Intra - above inter trochanteric line
Extrac- below intertrochanteric line
What is the garden’s type classification
- for intracapsular fractures
1&2 = slightly displaced = less risk of blood supply disruption
3&4 = more displaced = increase risk - 2 onwards is complete fracture
What are the risk factors of a hip fracture
- age
- osteoporosis
- low muscle mass
- steroids
- smoking
- alchohol
- metastatic spread of cancer to bone
What are the signs and symptoms of hip fracture?
Symptoms:
- hip and knee pain
- inability to bear weight
- limited motion range
Signs:
- bony tenderness over affected hip
- shortened/externally rotated leg
What imagining is required for investigation?
CXR, Plain films, MRI/CT, Cardiac echo
What is shentons line
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.
What are the steps of initial management?
- urine and blood routine investigations + catheter
- analgesia
- medication review
- pre op assessment
What is the surgical management?
Intracapsular types 1&2 - cannulated hip screws
Intracapsular types 3&4 - THR or hemi-arthoplasty
Extracapsular - dynamic hip screws or intra-medullary nails.
What things should be considered post-op
- daily reviews for chest and urinary infections
- increased risk of DVT ( prophylaxis dose LMWH)
- physiotherapy
What are the risk factors of delirium?
acutely developing behavioural change such as:
- altered cognitive function
- inattention
- disorganised thinking
- altered perception
- altered physical function
- altered social behaviour
- altered consciousness
What are the types of delirium?
Hyperactive - inappropriate behaviour, hallucinations and agitation.
Hypoactive- lethargy, reduced concentration and appetite.
Mixed - both types present
What are some triggers for delirium?
- infection
- drugs (opioids, steroids, sedatives, new prescription)
- surgery
- heart failure or MI
- hypo/erthyroidism
- dehydration
- environment change
What are the two key questions for a patient who has had a fall?
- why did they fall?
- what was the consequence of the fall?
What are the three subtypes of intracapsular fractures?
(From most proximal to distal)
1) sub capital
2) midcervical
3) basicervical
What are the 2 features of the demographic that have a higher risk of hip fractures
-65+
-Women
Describe bone composition.
Mineral - 70-80%
Organic matrix - 20-30%
Water - 5-10%
Cells - 2%
What are the cells found in bone
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
What is the bone modelling cascade?
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.
Why are women more likely to have hip fractures?
Menopause = ⬇️ Vit D and Ca+ = resportion>formation = osteoporosis
Why are older people more prone to fractures?
- fewer and fewer osteogenic cells turn into osteoblasts
- decrease in bone density
-less exposure to sim
What is sarcopenia
Syndrome characterised by progressive and generalised loss of muscle mass
Correlated with physical disability, falls and low bone density.
What is the mechanostat theory
Mechanostat theory is the theory that bone and muscle strength are linked.
⬆️ mechanical stimulus = ⬆️ bone formation.
What drugs increase bone density? And how?
Bisphosphonates
- attracted to bone
- ingested by osteoclasts
- blocks enzyme in osteoclast that stops its function
What are the contraindications of bisphosphonates?
- mainly GI, looks like phospholipids that line gut, gives passage for stomach acids
What other drugs can be given to osteoporosis patients?
- supplements for VIT D and Ca2+
-SERM for oestrogen
What xray is used for bone density?
DEXA
Score of -1 to +1 is normal
Anything less than -1 is worrisome
Less than -2 is osteoporotic
What is oestrodiol and what is it’s effect on osteoclast and osteoblasts cell function?
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
What is RANK L and how do we take advantage of it to treat osteoporosis in people intolerant of bisphosphonates
1) most powerful stimulant of osteoclast activity
2) can be blocked by osteoprotegerin or denosumab
