Hip Fracture - The Royal Berkshire NHS Foundation Trust

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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
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