The management of fragility fractures of the hip: a quality assessment project

Abstract

Fragility fractures of the hip (FFH) constitute the most serious complication of osteoporosis, carrying a mortality rate of up to 30% in the first year after injury. Less than 50% of affected patients will regain their pre-injury activity level.Surgical fixation of the hip fracture within 48 hours of injury, multimodal pain management, deep vein thrombo-prophylaxis, early physical therapy and simultaneous management of osteoporosis and frailty in a multidisciplinary approach constitute the standard of care for FFH to keep the mortality and morbidity rates as low as possible and prevent future fragility fractures. Aim:To assess the standard of care of FFH at our institution and determine areas of management which require more attention and improvement.methods: A retrospective review of clinical and radiographic records of all patients admitted at our institution for FFH from 1 January 2014 to 31 December 2014.The waiting time from admission to surgical fixation of the hip fracture, pain control and thrombo-prophylaxis strategies, rate of geriatric referrals and extent of osteoporosis management were assessed. Results:One-hundred-and-thirteen FFH were admitted from 1 January to 31 December 2014; 98 clinical records and 98 pelvis radiographs were included in the study. The other 15 clinical records were incomplete and were therefore excluded.The average waiting time from admission to surgery was 49 hours (range 9-120). All patients received low dose morphine, paracetamol and tramadol for perioperative pain control. Low molecular weight heparin and compression stockings were prescribed for thrombo-prophylaxis in all patients.Only two (2.04%) patients had some osteoporosis investigations ordered and none of the patients were referred to the geriatric department, and none were formally treated for osteoporosis. Conclusion:While the waiting time from admission to surgery was largely within the recommended time frame, there were no signs of a multidisciplinary approach to the management of FFH at our institution, leaving osteoporosis and frailty largely untreated.Key words: fragility fractures, hip, geriatric hip fractures, standard of care for hip fractures, osteoporosis, frailty care

Prevalence of Sarcopenia in Older South African Patients Following Surgery for Fragility Fractures of the Hip

“…Reduced muscle quantity was confirmed in the presence of an ASM of <20 kg in men and <15 kg in women. To account for differences in body size, the skeletal muscle mass index (SMI), expressed as ASM/height, 2 was calculated and reported. An SMI of <5.5 kg/m 2 for women and <7 kg/m 2 for men was regarded as indicative of low muscle quantity corrected for body size.…”

“…The World Health Organization has quantified this as forces equivalent to a fall from a standing height or less. 2,3 Sarcopenia is especially common in older people, with reported prevalence rates ranging between 5% and 13%, 4 and present in up to 44% of patients undergoing orthopaedic surgery. 5 A 3-fold increase in the risk of falls, a 4-fold increase in the risk of disability, and a significant increase in the risk of postoperative morbidity and mortality [6][7][8][9][10] have been ascribed to sarcopenia.…”

“…The World Health Organization has quantified this as forces equivalent to a fall from a standing height or less. 2 , 3…”

Etiology and prevalence of hyponatremia in geriatric patients with fragility hip fractures

“…A fragility fracture is a fracture resulting from a fall from standing height or less. These fractures, which most commonly occur in the hip, spine, or wrist, are an indication that the bones of the body have been weakened by underlying conditions [4,5]. The risk factors for hip fragility fractures are advanced age, sex, race, weight loss, lack of exercise, nutritional disorders, metabolic disorders, smoking, and alcohol use.…”

“…The risk factors for hip fragility fractures are advanced age, sex, race, weight loss, lack of exercise, nutritional disorders, metabolic disorders, smoking, and alcohol use. The majority of fractures of the femur neck are associated with osteoporosis-induced loss of bone mass [4]. Less commonly, other metabolic disorders such as osteomalacia and renal osteodystrophy, oncological diseases, and endocrinological disorders like diabetes mellitus (DM) and hyperthyroidism are also related to hip fractures.…”