Hip Fractures

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Posts: 708
Joined: 26 Feb 2013 09:59
Full Name: Kannivelu Badrinath
Name of Your College/Medical School: Madras Medical College, Madras, India

Hip Fractures

Post by Badri »

When Barry Humphries died in Australia following a hip fracture Dr Mark Porter wrote:

"Like many of you I was saddened to hear that Barry Humphries had died; he was much loved in the Porter household.However, I wasn’t surprised. When he broke his hip after a fall at home earlier in the year I feared the worst. While most people will recover, the prognosis remains poor.One in ten of the 70,000 or so people who break their hip every year in the UK will die within a month of their fall, and about one in three won’t survive the year.

Much of this terrible toll can be explained by the fact that hip fractures are most common in older frail people (one in four occur in care homes) who are at the end of their lives anyway, but broken bones are not an inevitable consequence of ageing. Indeed the National Institute for Health and Care Excellence (Nice) estimates that about20,000 hip fractures a year could be prevented if more was done to identify those most at risk.

And the two main warning signs are repeated falls and a previous “fragility fracture” — a break, typically of the arm, resulting from a low trauma slip or trip from standing height that indicates underlying osteoporosis (see below). About half of people who fracture their hip will have had at least one previous fragility fracture that heralded future problems which, if heeded, may have saved their hip. And their life.

Half a million people are treated for fragility fractures every year in the NHS and hospitals have become much better at following up with these patients. When I worked as a young surgeon in the Eighties, fractures such as broken wrists in middle-aged or older people didn’t ring alarm bells.Patients were simply sent home in plaster and reviewed weeks later in the clinic to check the bone had healed before being discharged.

Today the pathway in (most) emergency departments is very different. At the very least you are likely to be offered a bone scan (Dexa) to check for osteoporosis and/or medication to try and strengthen/maintain your bones to reduce the risk of future fractures. And the best hospitals go a step further and, through specialist falls clinics, explore why someone fell in the first place.

We all slip and trip, but if it is happening frequently it warrants closer attention. There are myriad possible causes, ranging from side effects of medication, vertigo, heart problems and seizures, to poor vision, general frailty/weakness, dementia and ill-fitting slippers and carpets. And it is the job of specialist falls clinics —and GPs and community frailty teams — to look for an underlying cause and mitigate them where possible."
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