Proximal femoral fractures + Elderly care Flashcards
why might a young person get a proximal femoral fracture
high energy trauma
what are the risk factors for proximal femoral fractures
risk doubles every 10 years after age 50 osteoporosis- females smoking malnutrition excess alcohol neurological impairment impaired vision
what lies between the greater and lesser trochanter
intertrochanteric line (anterior) intertrochanteric crest (posterior)
what is the blood supply to the femoral head
intramedullary artery of shaft of femur
medial and lateral circumflex branches of profundus femoris
artery of ligamentum teres
where does the hip capsule attach proximally and distally
edge of acetabulum proximally
distally- intertrochanteric line anteriorly and the femoral neck posteriorly
what proximal femoral fractures are at risk of losing blood supply
intracapsular ones
other than location, how else can you classify proximal femoral fractures
displaced or undisplaced
how can you classify extracapsular proximal femoral fractures
basicervical (on line where capsule attaches)
intertrochanteric
subtrichanteric
what are the complications of proximal femoral neck fractures
intracapsular: non-union, AVN
extra: caspular- malunion, non-union
what are the signs of an UNdisplaced proximal femoral fracture
shortening and external rotation
what is shenton’s line
imaginary line on X-ray which starts at lesser trochanter, follows neck of head of femur to the pubic ramus
what are the principles of hip fracture management
return to pre-fracture level of function
usually operation followed by mobilisation
early mobilisation to avoid complications of recumbency (pressure sores, pneumonia, DVTs, UTIs)
what surgery might young people get instead of hip arthroplasty
fixation
what surgery for elderly patients
old and fit- fixation or THR
old- cemented hemiarthroplasty
how can you tell whether its intra or extra capsular
how much on neck of femur is after the break
what is the ideal operative fracture journey
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
what are the big six interventions- done for all eldery hip fracture management
- Provision of Pain Relief
- Screening for Delirium
- Early Warning Score (EWS) system
- Full Blood Investigation and Electrocardiogram
- Intravenous Fluids Therapy
- Pressure Area Care
what pre op analgesia is used for hip fractures (in the elderly)
local nerve blocks given in A and E
what is delirium
an acute episode of confusion
what are the features of delirium
acute change/ fluctuating cognitive level
inattention
altered conscious level or disorganised thinking
what tool helps diagnose delirium
4AT tool
what is the management for delirium
treat underlying cause:
age, dementia, pain, drugs, constipation, change in environment, constipation, infection
ensure orientation, same nursing team, use families
what nutritional screening tool is used to asses old people
MUST
how quickly can pressure ulcers develop
after 30 mins
should elderly patient be repeated fasted before sugery
no
what operation should be standard for elderly NOF fractures
cemented hemi-arthroplasty implants
unless old but fit
what are the signs of dehydration and fluid overload
dehydration- skin, signs, urine
overloading- oedema, crackles in lungs- pulmonary oedema
what are the side effects of opiates
drowsiness, confusion, constipation, dizziness
what is the common analgesia for the elderly
paracetamol oral/ IV
codeine 15mg (can increase)
morphine
oxycodone if confused on morphine
when should an elderly patient be mobilised after surgery
by the end of the first day after surgery
physio by end of day 2
what assessment should elderly patients get if frail
geriatric assessment (within 3 days)
what assessment should be done for elderly patients before discharge
occupational therapy (by the end of day three)
what assessment should be done for elderly patients before discharge from acute orthopaedic ward
bone health
