Hip Fracture
description
Transcript of Hip Fracture
Hip Fracture
Dr Janet Lippett
Consultant Orthogeriatrician
October 2011
Hip Fracture
Overview
Facts and Figures
Hip Fracture – The Royal Berkshire Way
Orthogeriatrics
Pre-operative Assessment
Falls Assessment
Osteoporosis Assessment
Post operative Care and Rehabilitation
Hip Fracture
Hip Fracture
Facts and Figures
90% of patients admitted with a hip fracture are over 65.
10% die in the first 30 days; 30% die within a year.
Its common – average 450/yr in the RBH.
<50% return back to their own home.
80% of older women say they would rather die than experience the loss of independence and QOL associated with a hip fracture.
Fragility Fractures cost the UK health economy £1.8 billion a year
More bed days than stroke and heart disease
Hip Fracture
Hip Fracture – The Royal Berkshire Way
Pre 2007 liaison service
New Orthogeriatric Service set up in 2007
– Full time Consultant Orthogeriatrician
Achieving high standards in National Audits
– Top 10 in 2010 National Hip Fracture Database Annual Report
– Reduction in length of stay from 42 to 17 days
– Nearly 100% falls and bone health assessments
– Reduction in pressure sores
Hip Fracture
Orthogeriatrics
Pre-op assessment/optimisation, peri-operative complications, rehabilitation, falls and bone health assessments.
A good service reduces mortality, complications, length of stay and improves functional outcomes such as mobility and return to independence.
1940s Lionel Cosin – rehabilitation of neck of femur fracture patients
1950s Michael Devas and Bobby Irvine
2000s Janet Lippett and Apu Chatterjee
Hip Fracture
Pre-operative Assessment
Orthogeriatric medical assessment
Aim to get to theatre within 36 hours
2007 2011
Pre-op Assessment
20% 78%
Theatre within 48 hours
69% 92%
Hip Fracture
Hip Fracture
Hip Fracture
Falls Assessment
History
Medication Review
Gait and Balance
Home Hazard Assessment
Multidisciplinary Involvement
– Occupational Therapist and Physiotherapy
NHFD results 2011 – 99% of patients assessed
Hip Fracture
Osteoporosis
Commonest bone disease in adults
Reduction in bone density with a subsequent increased risk of fracture.
Life time risk of fracture in women over 50 is 1 in 2.
Falls and fractures account for more inpatient bed days than stroke and cardiovascular disease.
Osteoporosis is a “silent illness”.
NHFD 2011 – 98% of patients assessed (cf 45% in 2007)
Hip Fracture
Hip Fracture
Risk Factors
Gender
– F>M
Parental history of hip fracture
Previous fracture
– 2-5 fold increased risk
Low BMI
– Esp. if <20 kg/m2
Low Bone Mineral Density (BMD)
Smoking
– Dose dependent
Alcohol
– Esp. >3 units/day
Drugs
– Steroids, anticonvulsants, heparin, hormone treatments for cancer
Hip Fracture
What can we do - guidelines
NICE guidance
– Treat over 75s without investigation
FRAX and NOGG
– DEXA vs lifestyle vs treat
National Osteoporosis Society
– Usual guidance on the internet and has a local group
Hip Fracture
Hip Fracture
Hip Fracture
DEXA scanning
Hip Fracture
Lifestyle
Exercise
– Weightbearing – dancing, walking, aerobics
Diet
– Fruit and veg, fish, dairy products
Sunlight
– 10-20 mins exposure on base arms a day
Alcohol
– Reduce intake to <3 units per day
Hip Fracture
Drug Treatment
Calcium and Vitamin D for all
Bisphosphonates
– Mainstay of treatment – Alendronate
– Main side effect is indigestion
– Must sit up for 30 mins after, drink with whole glass of water and avoid food
Strontium
– Daily but doesn’t have complicated administration instructions
– Main side effect is diarrhoea
Hip Fracture
Post-operative Care and Rehabilitation
Post-operative complications
Tailor made rehabilitation programme
Woodley Ward
Community Rehabilitation
Inpatient Community Rehabilitation
National Hip Fracture Database
Hip Fracture
The Future
Fracture Liaison Service
– Improved service for femur fractures
– Service for non hip fractures
– Improved compliance with medication
– Support for patients
Hip Fracture
Thanks
Apu Chatterjee
Andrew McAndrew and the Orthopaedic Surgeons
Karen Barnard – Trauma Nurse Practioner
Helen Slade and Helen Mallock – Ward Managers
Liz Scott and the Physio team
Moyra Pugh and the OT team