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By Rachel Brown
Why do we need guidelines?
Ageing population increasing prevalence – 70,000-
75,000 hip fractures/year
Cost to NHS = £2 ...
What needs to be considered?
Timing
Analgesia
Anaesthesia
Surgical procedure
Mobilisation post-op
Patient and carer ...
Timing
Perform surgery on day of, or day after, admission
Identify and treat co-morbidities immediately so as
not to del...
Analgesia
Assess pain – on admission, 30 mins after analgesia
administration, hourly until patient settled, regularly
Gi...
Anaesthesia
Discuss risks and benefits with patient. Decide on
general vs. spinal anaesthesia
Surgical Procedure
Main aim – allow to weight bear immediately post-op
Options:
1. Internal fixation – intramedullary na...
Internal Fixation
Used when
fracture is:
non-displaced
and
intracapsular;
extra-capsular
Hip screw for
trochanteric
Nai...
Hemi-arthroplasty vs. Total
Used in displaced intra-capsular fracture
NICE recommends cement in all arthroplasties
Tota...
Post-op Mobilisation
ASAP
Offer patient physio assessment and mobilisation the
day after surgery
Mobilise at least once...
Patient and Carer Info
Give information and advise on:
o Diagnosis
o Anaesthesia
o Analgesia
o Surgical Procedure
o Compl...
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NICE guidelines of hip fractures

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NICE guidelines of hip fractures

  1. 1. By Rachel Brown
  2. 2. Why do we need guidelines? Ageing population increasing prevalence – 70,000- 75,000 hip fractures/year Cost to NHS = £2 billion a year 10% of people with hip fractures die within 1 month 1 in 3 patients die within 1 year of fracture
  3. 3. What needs to be considered? Timing Analgesia Anaesthesia Surgical procedure Mobilisation post-op Patient and carer info
  4. 4. Timing Perform surgery on day of, or day after, admission Identify and treat co-morbidities immediately so as not to delay surgery: Anaemia, anticoagulation, volume depletion, electrolyte imbalance, diabetes, HF, cardiac arrhythmia, acute chest infection, exacerbation of chronic chest condition
  5. 5. Analgesia Assess pain – on admission, 30 mins after analgesia administration, hourly until patient settled, regularly Give analgesia to - allow movements necessary for Ix, nursing care and rehab Paracetamol 6 hourly pre-op, additional opioid if insufficient (nerve block if opioid analgesia insufficent) Paracetamol 6 hourly post-op, additional opioid if insufficient NSAIDs not recommended
  6. 6. Anaesthesia Discuss risks and benefits with patient. Decide on general vs. spinal anaesthesia
  7. 7. Surgical Procedure Main aim – allow to weight bear immediately post-op Options: 1. Internal fixation – intramedullary nail, sliding hip screw 2.Hemiarthroplasty 3. Total arthroplasty
  8. 8. Internal Fixation Used when fracture is: non-displaced and intracapsular; extra-capsular Hip screw for trochanteric Nail for sub- trochanteric
  9. 9. Hemi-arthroplasty vs. Total Used in displaced intra-capsular fracture NICE recommends cement in all arthroplasties Total hip replacement recommended in: Patients able to walk independently outdoors with no more than the use of one stick prior to the fall, and those who are cognitively intact and who are medically fit.
  10. 10. Post-op Mobilisation ASAP Offer patient physio assessment and mobilisation the day after surgery Mobilise at least once a day and offer regular physio reviews
  11. 11. Patient and Carer Info Give information and advise on: o Diagnosis o Anaesthesia o Analgesia o Surgical Procedure o Complications o Post-op care and long term outcomes o Healthcare professionals involved

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