Fractured NOF Flashcards
:)
See other #NOF deck for cards from intro and Teach me surgery
Questions to ask in history for #NOF
- Fall history - nature of fall, landing, long lie?
- PMH - co-morbids, previous falls, chemo, OP etc
- DH - anticoags, warfarin
- SH - normal mobility, how to mobilise, support at home, ADL independence?
Clinical examination finding of #NOF
- Externally rotated
- Shortened
Physical exam of #NOF
- Roll legs on bed - exhibits pain usually
- Determine location of pain
- Full NV exam
Investigations on admission for #NOF and WHY
- FBC - cause of fall - anaemia? infection?
- Clotting screen and INR if warfarin - assess bleed risk for surgery and current bleeding from # risk?
- U&E, LFT - baseline
- CRP - infection?
- Creatine kinase - long lie, rhabdo
- X-ray pelvis - AP and lateral for hip
- Group and save - if needs blood in surgery
- ECG - arrhythmia for fall?
- Urine culture if suspect UTI
- PTH, Vitamin D, Calcium and PO4
Treatments that can be given in ED before hip # surgery
- Fluids
- Analgesia - opioid +/- regional block eg fascia iliaca block
What medications should be written on patients drug chart for #hip?
- Analgesia + LAXATIVE if opioid
- Any fluids given
- VTE prophylaxis
- Abx prophylaxis - given within 1 hr of skin incision though
What fluids should be given to patients with hip #?
- Isotonic crystalloids eg 0.9% saline
- Often dehydrated, restore IV volume
- Blood if lost a lot and Hb is very low
- Then maintenance fluid and correct electrolyte abnormalities - add K+ if low
Treatment for intracapsular displaced #NOF
- Total hip replacement or hemiarthroplasty
Consider total hip replacement rather than hemiarthroplasty for people with a displaced intracapsular hip fracture who:
* were able to walk independently out of doors with no more than the use of a stick and
* do not have a condition or comorbidity that makes the procedure unsuitable for them and
* are expected to be able to carry out activities of daily living independently beyond 2 years
Discussion during process of consenting for hemiarthroplasty
- Procedure in general
- Risks - VTE, bleeding, pain, dislocation, leg length differences, long term failure, infection, rare = nerve damage, bone damage, woumd healing problems, death
- Benefits - realign bone, promote healing, try to improve mobility
What is RESPECT form, what issues can occur from it?
- Involves discussions aboit ceiling of care, plans for resuscitation and end of life
- Includes DNAR
- Need to discuss if attempting CPR would benefit the patient or if it would cause harm, discomfort and loss of dignity
- Take into account patients opinion and views
- But sometimes there can be a disagreement with medical professional
What is Nottingham Hip Fracture score?
- Predictor of 30 day mortality post hip #
- Takes into account age, sex, AMTS, Hb on admission, if living in institution, co-morbidities and malignancy within last 20 years (not inc BCC and SCC)
- HOWEVER, there are significant differences across different trusts in how it predicts mortality
- Score of 6 or more seems to be high risk
Serum lactate and hip #
- Marker of mortality
- Increase in 1mmol/L = 1.9 fold increase in odds of 30 day mortality
- 3 mmol/L or more = high risk
What do team look for on x-ray post hemiarthroplasty?
- Leg length
- Position and rotation of femoral head
- Femoral stem positioning
- Distribution of cement
- Any post op #
- Osteolysis or luscency around prosthesis
- Joint space
- Soft tissue
Instructions from theatre team post op
- Abx prophylaxis continuation?
- Pain management directions
- Wound care
- Monitoring
- Restrictions - movement, showering etc
- Products given in surgery - blood, fluids etc
