Elderly Fall

Question 1

Answer 1

Question 2

What 3 bones comprise the hip and where are these fused?

Answer 2

Ilium, ischium and pubis → fused at the acetabulum

Question 3

The acetabulum is deepened by a fibrocartilaginous ring call the ________ and an ________ ligament, which helps may the hip joint a very congruous joint

Answer 3

Acetabular labrum, inferior acetabular

Question 4

Answer 4

Question 5

Answer 5

Question 6

List 3 examination findings of a NOF#

Answer 6

1. leg shortened and externally rotated
2. tenderness in groin and across the lateral hip (on the same side as #)
3. pain on all attempted movement of the affected leg

Question 7

On examination of a suspected NOF, what else must we check?

What would you expect the above to be?

Answer 7

1. Sensation
2. Pulses
3. Power - on dorsiflection, knee flexion and extension

All normal

Also a full CVS, resp, GI and NV exam should be completed

Question 8

DDX for NOF#

Answer 8

1. Fractured NOF
2. Pelvic fracture
3. Acetabular fracture
4. Femur fracture
5. Pathological fracture

Question 9

What does SBAR stand for?

Answer 9

Situation, background, assessment, recommendation

A format to summarise findings

Question 10

List 4 investigations you would do for a NOF# and why

Answer 10

1. X-ray: to view the area of interest
2. ECG: cardiac abnormalities which may have caused the fall
3. CRP - evidence of infection
4. FBC – anaemia as possible cause of fall

Question 11

List 3 sets of imaging we may do for a NOF#

Answer 11

1. X-ray pelvis – to include both hips
2. Affected hip x-ray, AP and lateral views
3. CT/MRI of the hip if any uncertainty

Question 12

What classification systems exists for intracapsular NOF#

Explain this classification

Answer 12

Gardens Classification - based on appearance on plain AP x-ray

Type 1 and 2

• minimal disruption of blood supply
• can often be fixed with internal fixation and screws

Type 3-4 →

• displacement, more likely to compromise blood supply to head of the femur (risk of AVN)
• usually treated with a hemiarthoplasty

Question 13

Identify the blood supply to the femoral head

Answer 13

Question 14

What is indicated by the yellow line and what is the clinical relevance?

Answer 14

Shentons line

Help identify abnormalities at the hip joint, it should be a smooth line as seen on the imagine

Question 15

List the 3 steps in management of a NOF# in the elderly

Answer 15

1. Medication
2. Referral and MDT approach
3. Surgery

Question 16

Medications used for management of a NOF#

Answer 16

1. Analgesia (pain ladder), iliofascial block
2. IV fluids (b/c NBM for theatre)
3. VTE prophylais (b/c immobile and undergoing lower limb surgery)

Question 17

What is the MDT approach for management of a NOF#

Answer 17

1. Refer to orthopaedics
2. Anaesthetic review prior to surgery
3. Physio and OT after surgery
4. Nursing care including wound care

Question 18

Which surgical management is advised for the following fractures:

1. Displaced subcapital
2. Inter-trochanteric and Basocervical
3. Non-displaced intra-capsular
4. Sub-trochanteric

Answer 18

Question 19

Best practice aims for theatre with in _______ hours of admission, or diagnosis if already an inpatient (due to high mortality)

Answer 19

36

Question 20

What score is used to assess risk of fragility fractures?

To what age group of men and women is this reccomended for?

Answer 20

FRAX score

• All women 65 +
• All men 75 +

Question 21

What investigation is used to assess bone mineral density?

How is it scored/ catagorised?

Answer 21

Dexa scan (Dual energy xray absorptiometry)

Measures bone density and gives a score based on the SD from the normal young adult

Question 22

What conservative management would you consider to help manage a patient with osetoporosis?

Answer 22

1. Good diet - adequate dietary calcium and Vit D
2. Reduce alcohol intake
3. Stop smoking
4. Regular weight bearing exercise
5. Avoid falls, use mobility aids, ensure floors are clear or trip hazards

Question 23

What medical management would you consider for the management of a patient with osteoporosis?

Answer 23

1. Calcium and Vit D supplements (if indicated)
2. Bisphosphonates eg. alendronic acid (prevent bone resorption)

Question 24

State the following regarding bisphosphonates

1. Advise for patient
2. Risks

Answer 24

1. Taken once weekly on an empty stomach, patient needs to sit upright for 30 minutes after
2. Risk of GI irritation, gastritis and bleeding