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Hip fracture

Clinical Discipline(s)/Organ System(s)
Geriatric Medicine, Musculoskeletal System, Orthopaedics, Endocrinology, Radiology
Progress Test Topic(s)
Musculoskeletal
Description
An 82 year old NZ European woman with a fractured neck of femur is brought to the Emergency Department by her neighbour. The woman is confused and unable to give a history but was found lying in her driveway. Earlier in the day, the neighbour heard the woman arguing with her son over him withdrawing money from her bank account. The medical records show a past history of chronic obstructive pulmonary disease, long-term oral corticosteroid use and surgical removal of a melanoma two years ago. An hour later her son arrives and says that he does not want her to have an operation.
Applied Science for Medicine 
   - Anatomy of the hip joint, pelvis and femur including blood supply to the femoral head
   - Pathophysiology of osteoporosis, osteomalacia, Paget's disease
   - Pathophysiology of metastatic disease
   - Pharmacology of anti-inflammatory corticosteroids
Clinical and Communication Skills 
   - History from patient who has had a fall; be aware of limitations when a patient has confusion
   - Examination of the hip; clinical findings in a fractured neck of femur and in a dislocated hip
   - Interpretation of pelvis X-ray
   - Classification of types of fractured neck of femur; outline management of neck of femur and pelvic fractures
   - Indications and perform femoral nerve block
   - Prognosis of a patient with a fractured neck of femur
   - Documentation of injuries in suspected abuse
   - Anaesthetic considerations in older patient with COPD
   - Role of the multidisciplinary team in discharge planning; making appropriate living arrangements post operatively
   - Diagnosis and treatment of osteoporosis and secondary prevention of osteoporotic fractures
   - Identify the possible causes for a fall, keeping in mind the multifactorial nature of falls in older people
Personal and Professional Skills 
   - Principles of best interest and patient advocacy
   - Understand consent and competence
   - Suspicion and recognition of abuse of older adults
   - Professional and sensitive communication with family/whānau when discussing sensitive topics
   - Awareness of personal views about a situation, and separation from professional role
Hauora Māori 
   - Culturally appropriate means of communication
Population Health 
   - Epidemiology of falls and impact of fractured neck of femur on individual
   - Increasing number of osteoporotic fractures with ageing population and costs to the health system
   - Strategies for preventing falls in older adults
Conditions to be considered relating to this scenario
Common
fractured neck of femur, pubic rami fracture, osteoporotic fracture, avascular necrosis, hip dislocation, visual impairment, Parkinson's disease, postural hypotension
Less common but 'important not to miss'
pathological fracture secondary to bone malignancy or metastatic disease, normal pressure hydrocephalus, progressive supranuclear palsy
Uncommon
Paget's disease, osteomalacia