Management of the Fractured Neck of Femur in the Elderly Female

1966 ◽  
Vol 8 (6) ◽  
pp. 321-326 ◽  
Author(s):  
A.N.G. Clark ◽  
D. Wainwright
Keyword(s):  
The Elderly ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Elderly Female

scholarly journals Preoperative and Postoperative Oxygen Saturation in the Elderly following Spinal or General Anaesthesia—An Audit of Current Practice

1994 ◽  
Vol 22 (2) ◽  
pp. 150-154 ◽  
Author(s):  
A. G. Brown ◽  
A. R. Visram ◽  
R. D. M. Jones ◽  
M. G. Irwin ◽  
J. Bacon-Shone
Keyword(s):  
Elderly Patients ◽  
Oxygen Saturation ◽  
Signal Amplitude ◽  
The Elderly ◽  
Analysis Data ◽  
General Anaesthetic ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Screw Insertion ◽  
Hip Screw

We have compared the incidence of preoperative and postoperative oxygen desaturation in 20 elderly patients undergoing dynamic hip screw insertion for fractured neck of femur, allocated randomly to two groups to receive subarachnoid anaesthesia (SA, n = 10) or a general anaesthetic (GA, n = 10). Oximetry data were recorded during the preoperative night and the first 48 hours after surgery using Satmaster.™ Data associated with zero amplitude signal were automatically invalidated by the software and decreases in SpO2 which were preceded by contemporaneous changes in signal amplitude which conformed to a previously described template were assumed to be artefactual and were discarded from final data analysis. Data demonstrated a wide interpatient variability. However, those patients who desaturated preoperatively continued to do so in the postoperative period. The differences between the preoperative and postoperative oximetry profiles were examined for each patient and demonstrated a significantly longer time spent with SpO2 <90% in the GA group compared with the SA group, in all the recorded time periods, except on the day of surgery. The SA group showed an improvement in oxygen saturation postoperatively when compared to the preoperative night, spending less time with an SpO2 <85%. We conclude that the subarachnoid anaesthetic technique was associated with a lower incidence of postoperative oximetry desaturation when compared with general anaesthetic for these elderly patients undergoing repair of fractured neck of femur.

RISK FACTORS FOR FRACTURED NECK OF FEMUR IN THE ELDERLY

1982 ◽  
Vol 11 (3) ◽  
pp. 160-168 ◽  
Author(s):  
R. WOOTTON ◽  
ELAINE BRYSON ◽  
U. ELSASSER ◽  
HEATHER FREEMAN ◽  
J. R. GREEN ◽  
...  
Keyword(s):  
Risk Factors ◽  
The Elderly ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur

scholarly journals Introducing the principles of Enhanced Recovery to a fractured neck of femur pathway 5 years results and experience

2020 ◽  
Author(s):  
Thomas Wainwright ◽  
Tikki Immins ◽  
Robert Middleton
Keyword(s):  
Relative Risk ◽  
Qualitative Data ◽  
Enhanced Recovery ◽  
Admission Rate ◽  
The Elderly ◽  
Outcome Data ◽  
Case Mix ◽  
Key Factors ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur

Introduction There is great potential for the principles of Enhanced Recovery to be successfully applied to fractured neck of femur (FNOF) pathways and help to improve clinical outcomes. Aim To present the 5-year results and experience from Poole Hospital of applying the principles of Enhanced Recovery to FNOF patients. Method A mixed-methods sequential explanatory design (QUAN emphasised) that consists of quantitative followed by qualitative data collected to evaluate the project. Quantitative outcome data were extracted from Hospital Episode Statistics for 2008/09 to 2013/14 and analysed using a relative risk methodology. Relative Risk is the ratio of the observed number of outcomes to the expected number of outcomes and is case-mix adjusted. The NHS England average is calculated and 95% confidence intervals are applied to determine statistical difference from unit performance to the equivalent case-mix. Qualitative data were collected via staff interviews. Results A mean length of stay (LOS) of 12.3 days, a mortality rate of 5.7%, a 28-day re-admission rate of 10.2%, and a discharge home rate of 55% achieved in the last year of the project are lower than expected for hospital case-mix Staff interviews highlighted that key factors for success were: 1.Collaborative practice across all teams 2.Input from the Department of Medicine for the Elderly 3.Changing the pre-operative mindset whereby instead of having to prove patients are fit for surgery, they are assessed as fit for surgery unless proven otherwise. Conclusions Enhanced Recovery can be successfully applied to FNOF patients in order to improve patient outcomes. However, implementation may be more challenging and take longer than for elective orthopaedic procedures.

Fractured Neck of Femur in the Elderly: An Attempt to Identify Patients at Risk

1979 ◽  
Vol 57 (1) ◽  
pp. 93-101 ◽  
Author(s):  
R. Wootton ◽  
P. J. Brereton ◽  
M. B. Clark ◽  
R. Hesp ◽  
H. M. Hodkinson ◽  
...  
Keyword(s):  
Calcium Absorption ◽  
Elective Surgery ◽  
The Elderly ◽  
Test Results ◽  
Serum Concentrations ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Patients At Risk ◽  
And Control ◽  
Two Populations

1. During a 15-month period, 110 elderly patients admitted with fractured neck of femur were studied in comparison with 72 elderly control patients undergoing elective surgery admitted over the same period to the same orthopaedic wards. 2. A striking finding was the marked similarity of all variables measured in the fracture and control groups. The principal differences between the two populations were that the fracture patients had a lower mean forearm bone mineral content, and that their serum concentrations of albumin, globulin and phosphate were reduced. 3. Neither measurements of radioisotopic calcium absorption, nor those of the serum concentrations of calcium, 25-hydroxy-vitamin D3 nor alkaline phosphatase provided satisfactory discrimination between the groups. 4. Several indices were devised, based on linear combinations of the test results obtained, in an attempt to predict the liability to future fractures of patients being considered for prophylactic therapy with oestrogens or other drugs. However, further work is required to define an index of improved predictive power and to evaluate it prospectively.

scholarly journals The use of computed tomography in identifying radiologically occult hip fractures in the elderly

2014 ◽  
Vol 96 (3) ◽  
pp. 234-237 ◽  
Author(s):  
S Heikal ◽  
P Riou ◽  
L Jones
Keyword(s):  
Computed Tomography ◽  
Hip Fractures ◽  
Historical Review ◽  
The Elderly ◽  
Acetabular Fractures ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
X Ray ◽  
Magnetic Resonance Imaging Mri ◽  
Occult Hip Fractures

Introduction Fractured neck of femur (NOF) is a cause of significant morbidity and mortality. Approximately 4% of patients with an initial normal hip x-ray in the emergency department (ED) will in fact have an occult fracture. In cases where there is ongoing clinical suspicion of NOF fracture despite a normal hip x-ray, alternative imaging should be used. Although available evidence supports the use of magnetic resonance imaging (MRI) for this, it is often not readily accessible from the ED. In our department, it is common practice to request computed tomography (CT). Methods A historical review was undertaken of all patients who presented between October 2007 and January 2011 who had CT requested by ED staff. Patients included in the study were those who presented following low impact trauma in whom fractured NOF was suspected despite a normal x-ray. Results Of the 65 included patients, fractures (pelvic and hip) were identified in 38 patients on CT. Fractured NOFs were found in 13 patients. Acetabular fractures were found in nine patients, five of whom required further orthopaedic management. One patient went on to have MRI to confirm the diagnosis of an impacted NOF fracture, suspected both on x-ray and CT. Further review was undertaken of the medical notes of discharged patients to identify any who reattended or required further imaging. No such cases were found. Conclusions This review has shown the use of CT to be a practical approach to improving the care of patients with occult hip fractures.

Fractured neck of femur in the elderly patient

2001 ◽  
Vol 62 (1) ◽  
pp. 59-59
Author(s):  
Warwick Marchant ◽  
Craig Goldsack
Keyword(s):  
Elderly Patient ◽  
The Elderly ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur
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