Hip Fractures

Bimodal distribution

Elderly population

Low energy falls

Osteoporotic

Most common presentation

Epidemiology and Risk Factors

Sex

F:M 3-4:1

Race

Caucasians

Age >65 yrs

Co-morbidities

Osteoporosis

Endocrine disorders

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Poor nutritient

Vit D and calcium deficiency

Medication

Steroid

Anticonvulsants

Diuretics

Environmental

poor lighting

Loose rugs

Cluttered floors

Clinical Presentation

Pain

Inability to Weight Bare

Leg held shortened

External rotated

Hx of fall

Associated injuries - fractures elsewherer

Young Adults

Work up

AP and lateral X-ray

Fast for surgery

Fluids

Routine bloods - FBC, U and E, Coag, G and H

Check medications

Hx

Clinical exam

ECG +/- CXR

+/- CT to r/o occult fracture

+/- full length femur in select circumstances

X-ray

Shenton's line

Radiological line

Indictaes hip fracture

Lesser Trochanter

Relativity of lesser trochanter to ramus

More visible

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Pre-Op management

IV fluids

Regular analgesis

NPO

Anaesthetic r/v

Consented and marked

Orthogeriatric review pre-op multidiciplinary team

Hip Fracture Antomy

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Intracapsular

Extracapsular

Blood supply prob not compromised

Blood supply often compromised

Hemiarthroplasty

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1/2 hip replacement

Dynamic hip screw

Fix

Replace

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Intramedullary nail

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Orthogeriatric Service

Devas (orthopod) and Irvine (geriatrician)

Recognitionof medical complexity