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Hip fracture
- 1. 18/10/19 Stav Debi, DaniStarodubsky, Shterna Aharon Hip Fracture in the geriatric patient
- 2. Introduction As the populationof older adults increases worldwide so too does the number of hip fractures. Older adults have weaker bone and are more likely to fall due to diminished balance, medication side effects, and difficulty maneuvering around environmental hazards. Clinicians in many fields are involved in caring for patients with hip fractures and should be familiar with the basic types, assessment, and management of these injuries.
- 3. Hip joint anatomy Thehip joint is a "ball and socket" joint consisting of the acetabulum (socket) and the femoral head (ball). The femoral neck connects the femoral head to the proximal portion of the femoral shaft and attaches to the intertrochanteric region The term "hip fracture" is applied to fractures in any of these locations.
- 4. Types of fractures Intracapsularfracture Extracapsular fractures
- 5. Epidemiology Worldwide, the totalnumber of hip fractures is expected to surpass 6 million by the year 2050. Age is the main risk factor for hip fractures. The incidence of hip fracture increases exponentially with age in both genders. The incidence rates vary from North to South Europe, with the highest being in Sweden and Norway and the lowest in France and Switzerland. Hip fractures are estimated to 72% of total fracture related health care costs.
- 6. Risk factors • Osteoporosis •Falls • Females gender • Low socioeconomic • Cardiovascular disease • Endocrine disorders (eg, diabetes, hyperthyroidism) • Medications that increase the likelihood of falling (eg, benzodiazepines, opioids, antidepressants)
- 8. Risk factors forFalls • Past history of a fall • Lower-extremity weakness • Age • Female gender • Cognitive impairment • Balance problems • Psychotropic drug use • polypharmacy • Arthritis • History of stroke • Orthostatic hypotension • Dizziness • Anemia • Syncope • Parkinson disease • Visual impairment • Alcohol use • Diabetes
- 9. Non operative vsoperative Delaying the surgical intervention by > 48 hours in hip fractures increases the risk of complications and corresponds to a significant decrease in 1 year survival.
- 10. Pre-operative considerations • Patientswith active comorbidities may require more extensive preoperative evaluation and medical management of these conditions prior to repair of their fracture. • Unless contraindicated, thromboembolic prophylaxis should be instituted in patients who are awaiting surgery. • Aggressive pressure ulcer prevention measures should be employed in patients in whom surgery is delayed beyond 24 to 48 hours.
- 11. Medical management: • Analgesiae.g lower doses of opioids • Thromboembolic prophylaxis — Patients with hip fracture are at high risk of venous thromboembolism. • Infection prophylaxis — Antibiotic prophylaxis for surgical site infection is indicated for any patient who undergoes surgery for hip fracture. • Delirium — Delirium is a common complication in hospitalized older adults, and occurs in as many as 61 percent of patients with hip fracture. • Prevention of constipation — Attention should be paid to prevent constipation, especially in patients who receive opioid analgesics. • Prevention of pressure ulcers • Bladder catheterization • Blood transfusion • Blood pressure control
- 12. Types of operativeprocedures
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- 15. Mortality Young patientswith trauma with often die within 24 hours from trauma itself, whereas elderly patients Often die later due to secondary complications. 3 in 4 hip fractures associated deaths related to preexisting medical conditions rather than the fracture itself. Mortality rate from hip fracture 6% and at 1 year 30% due to secondary complications. 1 year mortality men 35% and women 22%.
- 16. Ortogeriatrics a modernfield Orthogeriatrics or geriatric orthopaedics is the multi-disciplinary approach to the management of orthopedic disorders in geriatric patients. • An understanding of how the impact of trauma, anaesthesia and surgery will affect patients with physical and cognitive frailty is essential. • This usually requires orthopaedic surgeons working along side geriatricians with an expertise in this area.
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