Abstract
Hip fracture is a common and serious injury affecting the elderly. Many patients have co-morbidities which may need to be investigated and treated before surgery but, conversely, delay in surgical management of these patients leads to increased morbidity and mortality. The Scottish Hip Fracture Audit (SHFA)1 conducted in 2007 showed variations between hospitals in postponement rates for medical reasons. The report referred to 11 major clinical abnormalities described by McLaughlin2 that were associated with poor postoperative outcomes and should be corrected before surgery.
This prospective audit took place in Monklands hospital for a duration of 6 weeks. All patients admitted to the orthopaedic firm from 14th Oct 2012 to 26th November 2012 with confirmed fracture neck of femur were prospectively included in the audit. A detailed review of the notes took place to identify whether delays were appropriate according to McLaughlin.
There were a total of 23 patients admitted during the audit period of which 21 were operated on and 2 patients treated conservatively. The mean age of this cohort was 82.8 (range 55–91) with a male to female ratio of 1:1.3. Sixteen cases (76%) were operated on within 48 hours of admission (11 cases – 52% within 24 hours). Five cases (24%) were delayed by more than 48 hours. Three cases (14%) were delayed due to lack of theatre time. Two patients (9.5%) were delayed due to request of ECHO for ?new murmur.
Our practice of managing hip fracture patients is similar to other units in Scotland with a deferral rate of approximately 25%. The patients who have a major clinical abnormality were appropriately investigated and treated before the surgery. Further improvement in management of the theatre time is needed as surgery is delayed for >24 hours in approximately 15% of medically fit hip fracture patients.
