Geriatric hip - Dr. Ferguson

http://www.aafp.org/afp/2003/0201/p537.html

Geriatric Pts aren't Old Adults

- Fractures can occur with Low energy!
- Two anatomical location
        - Femoral neck (blood supply threatened if displaced)
        - Intertrochanteric ( capsule instertion)

X-rays needed for operative planning
- Ap pelvis, AP and lat ofhip, femur, knee

Occult Fx
    - MRI > CT, but CT is still much better than X-ray.

Fragility Fx
    - Needs medical consult
        - Improves operative outcome.
        - Fragility fracture orderset required for Medicare payment!

How to Classify
    - Open, Displaced, Comminuted (all yes/no questions)
            - Displaced = unstable and hip replacement (total vs hemiarthroolasty depends on functional status)
            - Non-displaced / stable (vagus deform)= screws
                - Low rates of AVN, Infection, Out Of Bed quickly

Outcomes
    - Mortality - 25% 1 yr mortality
    - Function - you lose some fuctional status active vs community walker vs house walker vs bed bound

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