Last updated on 17 Jun 2015 at 12:19 PM (M21)

Hip fracture
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