Hip Fracture Management Pathways in Older Adults

With Katren Tyler and Dane Stevenson

Hip fractures are a common injury among older adults and have a staggering one-year mortality of 20-30%. In this episode we discuss a multi-disciplinary pathway to improve the acute care of patients with hip fractures. It can help standardize care, improve pain control, decrease pain-related delirium, reduce the time from the ED to the operating room, and decrease the hospital length of stay. Also, if you have never heard of the fascia iliaca compartment block for pain management in patients with hip fractures, this could be practice-changing for you!

Resources

References

  1. Tinetti ME, Inouye SK, Gill TM, et al. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA 1995;273(3):1348–1353. PMID 7715059
  2. Godoy Monzon, D., et al. (2007). “Single fascia iliaca compartment block for post-hip fracture pain relief.” Journal of Emergency Medicine 32(3): 257-262. PMID 17394987
  3. Gottschalk, A., et al. (2015). “The Impact of Incident Postoperative Delirium on Survival of Elderly Patients After Surgery for Hip Fracture Repair.” Anesthesia and Analgesia. PMID 25590791
  4. Hogh, A., et al. (2008). “Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture.” Strategies Trauma Limb Reconstr 3(2): 65-70. PMID 18762870
  5. Kates, S. L., et al. (2015). “Financial Implications of Hospital Readmission After Hip Fracture.” Geriatr Orthop Surg Rehabil 6(3): 140-146. PMID 26328226 http://www.ncbi.nlm.nih.gov/pubmed/26328226
  6. Lees, D., et al. (2014). “Fascia iliaca compartment block for hip fractures: experience of integrating a new protocol across two hospital sites.” European Journal of Emergency Medicine. PMID 24949565
  7. Marcantonio, E. R., et al. (2000). “Delirium is independently associated with poor functional recovery after hip fracture.” Journal of the American Geriatrics Society 48(6): 618-624. PMID 10855596
  8. Mouzopoulos, G., et al. (2009). “Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study.” Journal of Orthopaedics and Traumatology 10(3): 127-133. PMID: 19690943
  9. Mundi, S., et al. (2014). “Similar mortality rates in hip fracture patients over the past 31 years.” Acta Orthopaedica 85(1): 54-59. PMID 24397744
  10. Stoneham, M., et al. (2014). “Emergency surgery: the big three–abdominal aortic aneurysm, laparotomy and hip fracture.” Anaesthesia 69 Suppl 1: 70-80. PMID 24303863

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Christina Shenvi

MD, PhD, FACEP
Bio

Dr. Christina Shenvi is an associate professor of Emergency Medicine at the University of North Carolina. She is fellowship-trained in Geriatric Emergency Medicine and is the founder of GEMCast. She is the director of the UNC Office of Academic Excellence, president of the Association of Professional Women in Medical Sciences, co-directs the ACEP/CORD Teaching Fellowship, is on the Annals of EM editorial board, is on the Geriatric ED Accreditation board of governors, and she teaches and writes about time management at timeforyourlife.org.

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