in elderly
Principle
- Assuming that the injury is closed, isolated and the limb is neurovascularly intact, I will follow the BOAST and NICE guidelines and involve a multidisciplinary team
- My protocol include
- Initial assessment and Initial management
- Definitive management
- Post operative management
Initial assessment and Management
- I will offer immediate analgesia (P-mol 6 hourly) to allow movement needed for investigations
- Identify and treat co morbidities
- Anaemia and anticoagulation
- Blood pressure
- Cardiac arrhythmia, ischemia and chest infection
- Diabetes
- Electrolyte imbalance
- MRI to be offered if not able to bear wt with normal X-ray. If not available, offer CT
- IV fluids are administered and appropriate blood tests undertaken
- Plan for surgery on the same day/ day after admission
6 standards of care
- Admit with in 4 hours
- Surgery with in 48 hours
- Minimise risk of pressure ulcer
- Ortho geriatric medical support
- Bone health assessment
- Fall prevention
Definitive treatment
- Planned trauma list
- I will offer replacement arthroplasty
- Cemented THR
- Able to walk in-depend out door with no more than 1 stick
- Cognitively unimpaired
- Anaesthetically fit
- Otherwise cemented hemiarthroplasty
- Use anterolateral approach
Key points
- If a hip fracture complicates or precipitates a terminal illness, the multidisciplinary team should still consider the role of surgery as part of a palliative care approach that:
- minimises pain and other symptoms and
- establishes patients' own priorities for rehabilitation and
- considers patients' wishes about their end-of-life care.
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| THA | Hemi | |
| Function | HHS 5 points better | Worse |
| Reoperation | RR: 0.57 | more |
| Dislocation | RR:1.5 | Less |
| General complication | RR: 1.1 | Less |
Post op
- Rehab prescription
- Early mobilisation
- Fall prevention
- anti resorptive treatment and
- secondary prevention
Garden classification
- (based on AP radiographs and does not consider lateral or sagittal plane alignment)
- Incomplete, ie. valgus impacted Type I
- Complete fx. nondisplaced Type II
- Complete, partially displaced Type III
- Complete, fully displaced Type IV