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Undisplaced fractures are managed with parallel implants. Hence, if the fracture is displaced, it is usually managed with hemi-arthroplasty. The blood supply to this area means that, if displaced, this type of fracture may disrupt the blood supply to the femoral head, causing it to collapse due to necrosis. FNF femoral neck fracture TF trochanteric fracture Sub-TF subtrochanteric fracture LFW lateral femoral wall (From Palm 2017 with permission) (more.)įemoral neck fracture: This occurs in the neck region of the femur in the intracapsular region (within the hip joint capsule). Avoiding the impact of this situation requires consideration of the following three principles :Īnteroposterior radiograph of the right side of the proximal femur showing anatomy and fracture positions. Assessment and subsequent care is best provided by effective multidisciplinary team working based on sound “orthogeriatric” principles treating the fracture while considering the causes and effects of the fall and the unstable comorbidities and initiating effective rehabilitation while considering bone health with the aim of preventing further fractures.Įmergency departments (EDs) are noisy, busy, overstimulating places, making them inappropriate care environments for vulnerable older people in a state of personal and physical crisis. The primary goal of nursing care for the older adult with fragility hip fracture is to maximise mobility and preserve optimal function psychosocial factors, however, must be incorporated into a holistic approach to care so that patients can be motivated to rehabilitate. Factors affecting outcomes following hip fracture are dominated by restoring function, so physical care attracts the most attention. Sustaining a hip fracture is a sudden traumatic event, threatening many aspects of patients’ lives and a forceful reminder of their mortality. Postoperative care includes, therefore, early mobilisation, pain management, postoperative hypotension and fluid management, postsurgical anemia management, delirium assessment and nutritional optimisation. The early postoperative phase is crucial, as delayed remobilisation is associated with prolonged hosptial stay. Postoperatively, orthogeriatric care aims to mitigate the effects of surgery and remobilise, re-enable and remotivate patients in preparation for discharge, ideally back to their place of residence before the fracture. Patients are at substantial risk of perioperative morbidity and mortality due to age and frailty, so they have decreased physiological reserve one or more comorbidities, polypharmacy and cognitive dysfunction are common and can have a negative impact on physiology. Intraoperative care aims to mitigate the pathophysiological effects of surgery without destabilising the patient’s physiology. The aim is to facilitate prompt preparation for surgery through coordinated orthogeriatric and anesthetic care. The goals are to stabilise the injury, manage pain and restore function, and standardised preoperative assessments and patient-centred management protocols are needed. The preoperative phase is the period prior to arrival in the operating department for surgery. There are three phases to perioperative care: preoperative, intraoperative and postoperative. Conservative management carries additional risks of immobility, thromboembolism, pressure injuries, other complications and loss of independence. Surgery is the preferred treatment for hip fracture because it provides stable fixation, facilitates full weight bearing and decreases the risk of complications. The principal skills and knowledge needed to look after patients with hip fractures well apply across the management of all older people with fractures and includes all the fundamental aspects of nursing care for the adult as well as specialised interventions for older people. Although the chapter is concerned with nursing interventions in orthogeriatric care generally, hip fracture is the most common reason for admission to an orthopaedic unit and the complexity of needs, prevalence, number of bed days and cost means that the focus of care tends to be predominantly on this category of injury. The aim of this chapter is to outline the care of older people with fragility fractures of the hip, the most significant injury requiring orthogeriatric care. The most common cause of injury in older people is a fall, so fall-related trauma will be the focus of this section while acknowledging that the care of elderly trauma, whatever the cause, is based on the same principles. Although management of older people following trauma has some similarities to that for all trauma, there are also differences and specific considerations relating to ageing. As the population ages, musculoskeletal trauma in older people will be a growing challenge.
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