Older Person Fracture Presentation and Management Including Tips for Pain Management

Abstract

Falls leading to hip injuries represent a quarter of all fall-related injury hospitalizations.1 A fall in a patient over 65 necessitating an Emergency Department (ED) visit carries a 15% mortality rate at one year.2 A neck of femur fracture is a common sequela that an Emergency Physician will manage after an older person falls. In Australia and New Zealand (ANZ) in 2021, there were 15,331 episodes of neck of femur fracture reported.3 Despite ongoing advances in standardization of care, the mortality rate of neck of femur fractures sits at 7.6% and 8.3% at one month in ANZ and the UK respectively with the 1-year mortality in ANZ sitting at 24.8% for 2021.3,4 The morbidity for this fracture is complex. An average length of stay of between 4 and 23 days illustrates the complexity of managing these patients on the wards. There is a 29.5% rate of postoperative delirium carrying its own mortality risk.5 At 120 days, only 70% of these patients will return home if they came from home and 60% will require mobility aid.3,4 Other issues that arise include pressure area prevention, comorbidity management, and frailty. The ANZ Hip Fracture Registry3 provides an approach for hospitals to audit the management of neck of femur fractures “against key markers of safe, high-quality care”. This registry aligns closely with the Australian Hip Fracture Clinical Care Standard.6 Issues highlighted in the standard and registry most pertinent to the ED include: