Hip Fracture: The Rest Isn't Orthopaedics

• 1. A model for multi-disciplinary care

  Hip fractures are the commonest reason for older adults to be admitted to hospital for emergency surgery — but the rest of their care isn’t about orthopaedics. Behind each fracture may lie frailty and a need for coordinated multidisciplinary teamwork. In this episode, we use hip fracture care as a lens to explore the wider challenges of caring for frail and older patients in hospital. From the early days of surgical defeatism to today’s orthogeriatric-led models and national audit, we ask: what can hip fracture care teach us about treatingolder adults more holistically? Links:‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4EzNICE Guideline: ⁠https://www.nice.org.uk/guidance/cg124⁠National Hip Fracture Database (NHFD): ⁠https://www.nhfd.co.uk/⁠BOA-BGS Blue Book:⁠ https://www.bgs.org.uk/sites/default/files/content/attachment/2018-05-02/Blue%20Book%20on%20fragility%20fracture%20care.pdf⁠Hip fractures in the elderly: a world-wide projection: Cooper et al. Osteoporosis Int. 1992. https://pubmed.ncbi.nlm.nih.gov/1421796/Geriatric Orthopaedics. Devas BMJ 1974. https://www.bmj.com/content/1/5900/190Effectiveness of geriatric rehabilitation after proximal femur fracture in the elderly: Kennie et al. BMJ 1988. https://pmc.ncbi.nlm.nih.gov/articles/PMC1834847/ Prospective randomised study of an orthopaedic geriatric in-patient service: Gilchrist et al. BMJ 1988. ⁠ https://pubmed.ncbi.nlm.nih.gov/3143450/Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures: Cameron et al. Cochrane Database 2001 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000106/references Questions and suggestions? Email: [email protected]

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• Trailer

  Welcome to Hip Fracture: The Rest Isn’t Orthopaedics! Dr. Raihaan Biju introduces season 1, which covers key medical topics — all viewed through the journey of a hip fracture patient.From acute care and delirium, nutrition, rehab, and preventing future falls and fractures, we break down the essentials of hospital care. Designed for the whole MDT, this series makes complex topics simple, practical, and relevant for everyone.

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• 7. Preventing the next fracture

  We’re almost ready to send Grace home! But if she does fall again, how can we prevent another fracture? In the final episode of our first season, we explore the key trials that have shaped our approach to bone health — from calcium and vitamin D to bisphosphonates such as alendronate, and finally zoledronate. We unpack the benefits and challenges of these treatments, and reflect on why bone protection is so important for the whole multidisciplinary team. Join us as we wrap up Season 1, bringing together everything we’ve learned about improving outcomes for patients like Grace.Links: ‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlistlist=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4EzPatient level pooled analysis of 68,500 patients from seven major vitamin D fracture trials in US and Europe: Abrahamsen et al. BMJ 2010 https://pubmed.ncbi.nlm.nih.gov/20068257/Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people: a randomised placebo-controlled trial: The RECORD Trial Group. Lancet 2005 https://pubmed.ncbi.nlm.nih.gov/15885294/Randomised trial of alendronate on risk of fracture in women with existing vertebral fractures: Fracture Intervention Trial Research Group. Lancet 1996 https://pubmed.ncbi.nlm.nih.gov/8950879/ Zoledronic acid, clinical fractures and mortality after hip fracture: Lyles et al. NEMJ 2007. https://www.nejm.org/doi/full/10.1056/NEJMoa074941National Hip Fracture Database: ⁠https://www.nhfd.co.uk/⁠Questions and suggestions? Email: [email protected]

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• 6. The tipping point; preventing falls

  In today’s episode, we return to Grace’s story, which began with a fall. Preventing the next fall is just as important as treating the consequences of the first. We look at why older adults fall, the major risk factors, and the strength of the evidence behind different interventions. Along the way, we discuss the key tests used to investigate falls and why they matter. Finally, we highlight the vital role of the multidisciplinary team in carrying out a comprehensive geriatric assessment, ensuring coordinated, patient-centred care that helps keep patients like Grace safe and independent.Links:‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4EzNICE Guidance Falls: ⁠https://www.nice.org.uk/guidance/ng249⁠Interventions for preventing falls in older people living in the community. Cochrane Database. https://www.cochrane.org/evidence/CD005465_interventions-preventing-falls-older-people-care-facilities-and-hospitalsFalls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Harwood et al. Br J Ophth. 2005 https://pubmed.ncbi.nlm.nih.gov/15615747/A multicentre randomised controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls. Age Ageing. 2010 https://pubmed.ncbi.nlm.nih.gov/20823124/Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls. Irvine L et al. Age Ageing. 2010 https://pubmed.ncbi.nlm.nih.gov/20833862/Multifactorial assessment and targeted intervention forpreventing falls and injuries among older people in community and emergencycare settings: systematic review and meta-analysis. Gates et al. BMJ 2008. https://pubmed.ncbi.nlm.nih.gov/18089892/Screening and intervention to prevent falls and fractures in older people. Lamb et al. N Engl J Med. 2020;383(19):1848-1859. https://www.nejm.org/doi/full/10.1056/NEJMoa2001500Questions and suggestions? Email: [email protected]

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• 5. Feeding recovery; the importance of nutrition

  Nutrition is often the missing piece in hip fracture recovery — yet it can mean the difference between regaining independence or facing decline. In this episode, we unpack the evidence behind nutrition, or lack thereof, as well as ward-based strategies such as red trays and dietetic assistants. We also highlight the vital role family members play. Drawing on both research and real-world practice, we show why nutrition isn’t just supportive care, but a frontline therapy where families and healthcare teams must work hand in hand.Links: ‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4EzFrailty in older adults: evidence for a phenotype: Fried et al. J Gerontol A Biol Sci Med Sci. 2001 https://pubmed.ncbi.nlm.nih.gov/11253156/Nutritional supplementation for hip fracture aftercare in older people. Avenall et al. Cochrane Database Syst Rev. 2016 Nov 30;11(11):CD001880, ⁠ https://www.cochrane.org/evidence/CD001880_nutritional-supplementation-older-people-after-hip-fractureReducing nutritional risk in hospital; the red tray: Bradley et al. Nursing Standard 2003 https://pubmed.ncbi.nlm.nih.gov/12677818/Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward: Duncan, Hood, Beck, Johansen, Age Ageing 2006; 35:148-153, ⁠https://doi.org/10.1093/ageing/afj011⁠ Questions and suggestions? Email: [email protected]

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