Orthogeriatrics

Question 1

In terms of hip fractures, what is the mortality at 1 year? What % reach previous independence level and what % from home move into care facilities?

Answer 1

30% mortality at 1 year.
50% return to same independence.
10-20% move into residential care.

Question 2

Orthogeriatric care is multidisciplinary. What are the 4 components of its goals?

Answer 2

Fracture care.
Rehab and discharge planning.
Secondary prevention of future fractures.
Support & education of patient and family/carers.

Question 3

Roughly what proportion of men & women over 60yo will have a pathological fracture due to osteoporosis? Is the number of hip fractures expected to decrease or increase?

Answer 3

1 in 3 men, 1 in 2 women.

Incidence is decreasing (osteoporosis being treated); but raw number increasing as population ages.

Question 4

What is the significance of classifying hip fractures of intracapsular or extracapsular? Which category do sub & intertrochanteric belong to?

Answer 4

Intracapsular has high risk of avascular necrosis of femoral head - blood supply enters along line of joint capsule.
Trochanteric ones are extracapsular.

Question 5

What are 4 things to consider pre-operatively before surgery for a hip fracture (ie. urgent surgery in an elderly person)

Answer 5

Fitness (consider cardiac, electrolyte, volume, diabetes, anticoagulation).
Tests: blood (coags, FBE); imaging; ECG.
Capacity to consent.
Fasting, fluid & sugar management.

Question 6

What are 3 fixation types that are generally used for non-displaced hip fractures?

Answer 6

Dynamic hip screw (plate + screws).
Cannulated screws (screws alone)
Intramedullary nails (also in displaced)

Question 7

What are 3 fixation types that are generally used for displaced hip fractures?

Answer 7

Partial or total hip replacement (hemi or total arthroplasty).

Question 8

What are 3 examples of when surgical fixation of hip fracture is not indicated?
Can it be done with palliative intent?

Answer 8

Terminal illness with imminent death.
Inability to undergo anaesthetic (eg. resp compromise)
Able to weight-bear and patient prefer no surgery.
Can be palliative - reduce pain & allow care.