88SHOULD NECK OF FEMUR FRACTURES (NOFF) BE ADMITTED UNDER JOINT CARE - A REVIEW OF A NOVEL HIP FRACTURE PATHWAY AT PRINCESS ALEXANDRA HOSPITAL

2019 ◽  
Vol 48 (Supplement_1) ◽  
pp. i24-i25
Author(s):  
J Snook ◽  
M Kaneshamoorthy ◽  
P Seguera ◽  
T Lopez
Keyword(s):  
Hip Fracture ◽  
Princess Alexandra Hospital ◽  
Neck Of Femur ◽  
Femur Fractures

scholarly journals Bilateral Neck of Femur Fractures in a Bilateral Below-Knee Amputee: A Unique Case

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Hannah R. Lancer ◽  
Peter Smitham ◽  
Pinak Ray
Keyword(s):  
Hip Fracture ◽  
Daily Activities ◽  
General Anaesthetic ◽  
Unique Case ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Total Hip Replacements ◽  
Walking Aids ◽  
Hip Replacements

According to the National Hip Fracture Database, over 64,000 patients were admitted with a hip fracture across England, Wales, and Northern Ireland in 2013, but very few are bilateral, and there are no current cases in the literature of bilateral neck of femur fractures in a patient with bilateral below-knee amputations. We present a case of a 69-year-old bilateral below-knee amputee male admitted to the emergency department with bilateral hip pain and radiological evidence of bilateral displaced neck of femur fractures. The patient subsequently underwent synchronous bilateral total hip replacements under general anaesthetic and an epidural and then went on to make a full recovery. He was discharged 27 days after arrival in hospital. Outpatient follow-up at 3 months has shown that the patient has returned to a similar level of preinjury function and is still able to carry out his daily activities with walking aids and bilateral leg prostheses.

Does the Nottingham Hip Fracture Score Help Predict Which Patients Will Benefit From a Modern Modular Hemiarthroplasty for the Treatment of Intracapsular Proximal Femoral Fractures?

2021 ◽  
Author(s):  
Sush Ramakrishna Gowda
Keyword(s):  
Hip Fracture ◽  
Femoral Fractures ◽  
High Volume ◽  
Neck Of Femur ◽  
Residential Status ◽  
Orthopaedic Department ◽  
Femur Fractures ◽  
Modular Prostheses ◽  
The Uk ◽  
To Receive

Introduction: Hemiarthroplasty for the management of intracapsular neck of femur fractures is common but current practice in the UK still varies regionally and individually. Guided by the National Institute of Health and Care Excellence (NICE) we have observed a move towards modern, modular prostheses such as the Exeter V40 Stem but the use of older, monoblock prostheses such as the Thompsons Hemiarthroplasty remains controversial. Use of the Nottingham Hip Fracture Scores (NHFS) can help surgeons stratify patients according to risk and select the most appropriate prosthesis to meet their individual needs. Materials and Methods: 765 hip hemiarthroplasties were analysed over a 28-month period at a single, high-volume, orthopaedic department in the UK. We calculated the NHFS and recorded the choice of prosthesis. Patients were then followed up for at least a year. Outcomes were mortality and change in residential status. Results: Six hundred and forty-six (446) patients were treated with monoblock prostheses (mean age=85.6; range 62-105). 319 patients received modular prostheses (mean age=81.0; range 61-98). Patients who were selected to receive a monoblock prosthesis were over twice as likely to be dead at a year (32.87% vs. 13.65%) and over twice as likely to require increased assistance with living (50.12% vs. 23.81%). Amongst patients with equivocal NHFS, those who receive a monoblock stem suffered worse outcomes in all but the very highest risk group, who experienced lower mortality (OR=0.71, CI 0.52-0.96) and change in residential status (OR=0.76, CI 0.58-0.99). Conclusion: Nottingham Hip Fracture Score (NHFS) can confer predictable outcomes in hip fracture patients treated with modular stems. Modular stems should be the default choice when performing hemiarthroplasties for intracapsular neck of femur fractures. However, in keeping with other studies, we found that in very old, frail, or co-morbid patients, modular stems are not associated with better survival or return to pre-morbid function.

scholarly journals Improving Administration of Fascia-iliaca Blocks for Patients With a Fractured Neck of Femur by Clinical Audit

2021 ◽  
Author(s):  
Isaac Okereke ◽  
Sridhar Rao Sampalli
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Femur Fracture ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Analgesic Effects ◽  
Femur Fractures ◽  
Anaesthetic Agents ◽  
Number Of Patients ◽  
Neck Of Femur Fracture

Abstract BackgroundHip fracture is the most common serious injury in older people. It is also the most common reason for older people to need emergency anaesthesia and surgery, and the commonest cause of death following an accident. A FICB is the injection of anaesthetic agents into the fascia- iliaca compartment with the effect of blocking the lumbar plexus via an anterior approach. FICB is clinically safe and efficient and provides consistent analgesic effects irrespective of the performing doctor's experience of frailty fractures of the proximal femur.Methods Data from the National Hip Fracture Database (NHFD) for all patients admitted with a neck of femur fracture between October 2018 and May 2019 was interrogated and audited. Results of this audit were discussed in the department of Trauma & Orthopaedics' and the Trust's mortality review meetings. Teaching sessions were held for doctors and filling out of the neck of femur fracture proforma to detail administration or not of FICB and a valid reason when the later occurred was encouraged. A re-audit was carried out in May 2020 where a retrospective study of patients admitted with a neck of femur fracture over six months from October 2019 to April 2020 was done to assess improvement in compliance rates of administration of fascia iliaca blocks.Results We noted a statistically significant increase in the number of patients who got a fascia iliaca block on presentation with a fractured neck of the femur from after our second audit (p<0.00001). There were no complications associated with the administration of FICB to patients with neck of femur fractures. ConclusionThis study showed that clinical processes could be improved through audits, staff education and by employing the use of proformas to ensure compliance.

scholarly journals Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis

JRSM Open ◽  
2017 ◽  
Vol 8 (3) ◽  
pp. 205427041667508 ◽  
Author(s):  
Rafik RD Yassa ◽  
Mahdi Y Khalfaoui ◽  
Karunakar Veravalli ◽  
D Alun Evans
Keyword(s):  
Urinary Tract Infection ◽  
Risk Factor ◽  
Urinary Tract ◽  
Hip Fracture ◽  
Tract Infection ◽  
Surgical Site Infection ◽  
Site Infection ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Tract Infections

Objective The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. Design A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. Setting UK University Teaching Hospital Participants All patients ( n = 460) presenting across a single year study period with a confirmed hip fracture. Outcome measures The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. Results A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection ( p-value: 0.0005). Conclusion The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection.

scholarly journals P22: CONSERVATIVE MANAGEMENT OF NECK OF FEMUR FRACTURES

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
S Tan ◽  
L Hoggett ◽  
Q Choudry ◽  
S Aithal ◽  
A Bokhari
Keyword(s):  
Decision Making ◽  
Hip Fracture ◽  
High Mortality ◽  
Conservative Management ◽  
Operative Management ◽  
Careful Consideration ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
The Mean ◽  
Clinical Conditions

Abstract Introduction According to NICE CG124, the gold standard of treatment for neck of femur (NOF) fractures is operative management on the day or day after admission. In practice, this is not always achievable depending on various factors, e.g. patient preference, clinical condition and theatre availability, with a further subset of patients undergoing conservative management. Method A retrospective analysis was performed on all NOF fractures managed non-operatively at a single centre from January 2017 to August 2019 by case notes analysis and review of radiographical images. Demographics, fracture type, pre-fracture mobility status, co-morbidities, mortality and Nottingham Hip Fracture Score (NHFS) are reported. Where applicable, our dataset is correlated with the National Hip Fracture Database for comparison. Result 24 patients were included in the study period, with a mean age of 79.9 years (range 54-99 years) and male:female ratio of 0.85:1. The mean NHFS (n=18) was 5.7 (range 3-8) and at least 62.5% (n=15) were deemed unfit for surgery or arrested pre-operatively. Conservatively managed NOF fractures are associated with a 30-day mortality of 41.7% compared to the centre average of 8.2% and national average of 6.9% for all NOF fractures. Overall mortality within 1 year is 95.5% (n=22). Conclusion Our study confirms that the conservative management of NOF fractures is associated with high mortality, however it may be the only treatment option acceptable in patients who are limited by unfavourable clinical conditions. Therefore, the decision for conservative management in NOF fractures requires careful consideration with the need for an established decision-making pathway. Take-home message The conservative management of neck of femur fractures is associated with high mortality, therefore requires careful consideration with the need for an established decision-making pathway.

scholarly journals 193 An Audit of Compliance for NICE Guidance of Management of Displaced Intracapsular Neck of Femur Fractures

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Sheen ◽  
G Higgins
Keyword(s):  
Hip Fracture ◽  
Neck Of Femur ◽  
Nice Guideline ◽  
Femur Fractures ◽  
Fracture Management ◽  
Nice Guidance ◽  
Using Data ◽  
Operation Note ◽  
Management Recommendations

Abstract Introduction The 2011 NICE guideline ‘CG124 Hip fracture: management’ covers the management of hip fractures in adults aged over 18. It was updated in 2017 to highlight the role of total hip replacement in intracapsular fracture management – Recommendations 1.6.2 and 1.6.3. The aim of this audit was to assess, and improve, the compliance of Torbay Hospital’s management of intracapsular neck of femur fractures. Method The study was split over the three cycles, using data from the National Hip Fracture Database, followed by a review of patient notes. The first audit of 2017 data assessed the compliance of the department. A first change was then implemented to operation note documentation and 2018 data analysed. A further change was then implemented to operation notes and 2019-2020 data analysed. Results The 2017 audit showed a compliance of 67.7% against statement 1 and 41.1% against statement 2. After the initial change, the 2018 re-audit showed a slight improvement to 76.0% and 54.9%. After the second change was made, compliance subsequently rose to 100% and 100%. Conclusions The initial compliance with NICE guidance was poor. Following changes to the documentation on the operation note, compliance rose to 100%.

The impact of COVID-19 on 30-day mortality in patients with neck of femur fractures

2020 ◽  
Vol 1 (7) ◽  
pp. 326-329 ◽  
Author(s):  
James E. Archer ◽  
Siddhant Kapoor ◽  
Danielle Piper ◽  
Abdulrahman Odeh
Keyword(s):  
Hip Fracture ◽  
Femur Fracture ◽  
Early Mobilization ◽  
Early Assessment ◽  
Optimal Care ◽  
Neck Of Femur ◽  
Hip Fracture Surgery ◽  
Femur Fractures ◽  
Neck Of Femur Fracture ◽  
The Impact

Aims The COVID-19 pandemic presents a significant threat to patients with neck of femur fractures. The 30-day mortality for these patients has gradually been reducing in the UK due to a multitude of inputs aimed at improving their outcomes. We provided an early assessment of 30-day mortality in neck of femur fracture patients who contracted COVID-19. Methods We identified 18 patients who were admitted from three acute hospital sites who underwent an operation for a neck of femur fracture and were diagnosed with COVID-19 between 25 March and 25 April 2020. We collected information on their age, American Association of Anesthesiologists (ASA) grade, diagnosis, surgical procedure, complications, and 30-day mortality. Results Our study identified 18 patients who were all diagnosed with a positive swab result during the postoperative period. Female patients made up two-thirds of the patient cohort and the mean age of patients was 82 years (55 to 101). In all, ten patients sustained intracapsular fractures with eight sustaining extracapsular fractures. The 30-day mortality in this group of patients was 22.2% as compared to 4% 30-day mortality in those without COVID-19. Conclusion Our results show a 30-day mortality of 22.2%, which is higher than the national average provided by the 2019 National Hip Fracture Database report. However, while 30-day mortality has increased in those patients with COVID-19, this should not impact upon the provision of hip fracture surgery as it provides significant benefits to the patient such as pain relief and early mobilization. However, the information presented in this study should form an important part of the informed consent process for surgery. A multidisciplinary approach is crucial in ensuring optimal care for this complex patient group. Cite this article: Bone Joint Open 2020;1-7:326–329.

scholarly journals New drug, new problem: do hip fracture patients taking NOACs experience delayed surgery, longer hospital stay, or poorer outcomes?

2019 ◽  
Vol 30 (6) ◽  
pp. 799-804 ◽  
Author(s):  
George JM Hourston ◽  
Michael P Barrett ◽  
Wasim S Khan ◽  
Madhavi Vindlacheruvu ◽  
Stephen M McDonnell
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Warfarin Therapy ◽  
Oral Anticoagulants ◽  
Linear Regression Analysis ◽  
Neck Of Femur ◽  
Prolonged Length ◽  
Delayed Surgery ◽  
Time To Surgery ◽  
Femur Fractures

Introduction: Neck of femur fractures are common in the comorbid, often anticoagulated, elderly. Non-vitamin K antagonist oral anticoagulants (NOACs) may affect patient outcomes. We aimed to evaluate whether hip fracture patients admitted on warfarin or NOAC therapy were at risk of operative delay, prolonged length of stay, or increased mortality. Methods: We collected data for 845 patients admitted to our centre between October 2014 and December 2016. Multivariable linear regression analysis was performed to test the association between warfarin and NOAC therapy on time to surgery and length of stay. Variables in the regression model were age, sex, admission AMTS, pre-fracture mobility, ASA score, fracture type, and operation type. Fisher’s exact test was used to evaluate whether warfarin or NOAC therapy delayed surgery beyond 36 or 48 hours, or decreased 30-day, 6-month, or 12-month survival. Results: Time to surgery was delayed in anticoagulated patients ( p = 0.028). NOAC therapy was independently associated with increased time to surgery beyond 36 hours ( p = 0.001), although not beyond 48 hours ( p = 0.355), whereas warfarin therapy was not associated with either. Anticoagulation did not increase length of stay ( p = 0.331). Warfarin therapy significantly reduced 30-day survival ( p = 0.007), but NOAC therapy did not ( p = 0.244). Neither warfarin nor NOAC therapy affected further survival. Conclusions: NOAC therapy delays time to surgery beyond the NHS England ‘Best Practice Tariff’ in hip fracture patients. We aim to prospectively investigate long-term outcomes. Without a NOAC antidote, policy must change to ensure time-appropriate surgery for patients on NOACs. Preoperative involvement of the haematology team is essential.

scholarly journals Investigation of Occult Hip Fractures: The Use of CT and MRI

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
S. K. Gill ◽  
J. Smith ◽  
R. Fox ◽  
T. J. S. Chesser
Keyword(s):  
Hip Fracture ◽  
Multislice Ct ◽  
Clinical Suspicion ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Occult Hip Fracture ◽  
Magnetic Resonance Imaging Mri ◽  
Current Guidelines ◽  
Ct And Mri

Aim. At present there is no data looking at modern multislice computerised tomography (CT) in the investigation of occult hip fracture. The aim of this study was to retrospectively compare the reports of patients sent for magnetic resonance imaging (MRI) or CT with negative radiographs and a clinical suspicion of a fractured neck of femur.Methods. All patients presenting to the hospital with a clinical suspicion of a hip fracture but initial negative radiographs over a three-year period were included. Patients were either investigated with an MRI scan or CT scan. The presence of a fracture, the requirement for surgery, and any further requirement for imaging were recorded.Results. Over three years 92 patients were included of which 61 were referred for a CT and 31 for an MRI. Thirty-four patients were found to have a fracture. Of these, MRI picked up a fracture in 36% and CT in 38% of referrals.Discussion. Up to 10% of proximal femur fractures may be missed on initial radiographs. Current guidelines state patients should be offered MRI if hip fracture is suspected despite negative hip radiographs. Our findings show that modern multislice CT may be comparable with MRI for detecting occult fracture.

scholarly journals Correction to: Hemiarthroplasty for neck of femur fractures: to cement or not? A systematic review of literature and meta-analysis

2019 ◽  
Vol 29 (8) ◽  
pp. 1835-1836
Author(s):  
Prasoon Kumar ◽  
Rajesh Kumar Rajnish ◽  
Deepak Neradi ◽  
Vishal Kumar ◽  
Saurabh Agarwal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Review Of Literature ◽  
Neck Of Femur ◽  
Femur Fractures
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