Proximal femoral fractures + Elderly care

Question 1

why might a young person get a proximal femoral fracture

Answer 1

high energy trauma

Question 2

what are the risk factors for proximal femoral fractures

Answer 2

risk doubles every 10 years after age 50 
osteoporosis- females
smoking 
malnutrition 
excess alcohol 
neurological impairment 
impaired vision

Question 3

what lies between the greater and lesser trochanter

Answer 3

intertrochanteric line (anterior)
intertrochanteric crest (posterior)

Question 4

what is the blood supply to the femoral head

Answer 4

intramedullary artery of shaft of femur

medial and lateral circumflex branches of profundus femoris

artery of ligamentum teres

Question 5

where does the hip capsule attach proximally and distally

Answer 5

edge of acetabulum proximally

distally- intertrochanteric line anteriorly and the femoral neck posteriorly

Question 6

what proximal femoral fractures are at risk of losing blood supply

Answer 6

intracapsular ones

Question 7

other than location, how else can you classify proximal femoral fractures

Answer 7

displaced or undisplaced

Question 8

how can you classify extracapsular proximal femoral fractures

Answer 8

basicervical (on line where capsule attaches)
intertrochanteric
subtrichanteric

Question 9

what are the complications of proximal femoral neck fractures

Answer 9

intracapsular: non-union, AVN
extra: caspular- malunion, non-union

Question 10

what are the signs of an UNdisplaced proximal femoral fracture

Answer 10

shortening and external rotation

Question 11

what is shenton’s line

Answer 11

imaginary line on X-ray which starts at lesser trochanter, follows neck of head of femur to the pubic ramus

Question 12

what are the principles of hip fracture management

Answer 12

return to pre-fracture level of function
usually operation followed by mobilisation
early mobilisation to avoid complications of recumbency (pressure sores, pneumonia, DVTs, UTIs)

Question 13

what surgery might young people get instead of hip arthroplasty

Answer 13

fixation

Question 14

what surgery for elderly patients

Answer 14

old and fit- fixation or THR

old- cemented hemiarthroplasty

Question 15

how can you tell whether its intra or extra capsular

Answer 15

how much on neck of femur is after the break

Question 16

what is the ideal operative fracture journey

Answer 16

prompt admission to orthopaedic care
rapid assessment (medical, surgical and anaesthetic)
the ‘big six’ interventions
minimal delay to surgery (within 36 hours)
good surgery
prompt mobilisation and prevention of complications
early rehab
early discharge
secondary prevention- falls and bone health assessment

Question 17

what are the big six interventions- done for all eldery hip fracture management

Answer 17

1. Provision of Pain Relief
2. Screening for Delirium
3. Early Warning Score (EWS) system
4. Full Blood Investigation and Electrocardiogram
5. Intravenous Fluids Therapy
6. Pressure Area Care

Question 18

what pre op analgesia is used for hip fractures (in the elderly)

Answer 18

local nerve blocks given in A and E

Question 19

what is delirium

Answer 19

an acute episode of confusion

Question 20

what are the features of delirium

Answer 20

acute change/ fluctuating cognitive level
inattention
altered conscious level or disorganised thinking

Question 21

what tool helps diagnose delirium

Answer 21

4AT tool

Question 22

what is the management for delirium

Answer 22

treat underlying cause:
age, dementia, pain, drugs, constipation, change in environment, constipation, infection

ensure orientation, same nursing team, use families

Question 23

what nutritional screening tool is used to asses old people

Answer 23

MUST

Question 24

how quickly can pressure ulcers develop

Answer 24

after 30 mins

Question 25

should elderly patient be repeated fasted before sugery

Answer 25

no

Question 26

what operation should be standard for elderly NOF fractures

Answer 26

cemented hemi-arthroplasty implants

unless old but fit

Question 27

what are the signs of dehydration and fluid overload

Answer 27

dehydration- skin, signs, urine

overloading- oedema, crackles in lungs- pulmonary oedema

Question 28

what are the side effects of opiates

Answer 28

drowsiness, confusion, constipation, dizziness

Question 29

what is the common analgesia for the elderly

Answer 29

paracetamol oral/ IV
codeine 15mg (can increase)
morphine
oxycodone if confused on morphine

Question 30

when should an elderly patient be mobilised after surgery

Answer 30

by the end of the first day after surgery

physio by end of day 2

Question 31

what assessment should elderly patients get if frail

Answer 31

geriatric assessment (within 3 days)

Question 32

what assessment should be done for elderly patients before discharge

Answer 32

occupational therapy (by the end of day three)

Question 33

what assessment should be done for elderly patients before discharge from acute orthopaedic ward

Answer 33

bone health