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
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 Pre-op Assessment 20%78% Theatre within 48 hours 69%92%
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
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
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