The management of fragility fractures of the hip: a quality assessment project

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dc.contributor.advisorMaqungo, Sithomboen_ZA
dc.contributor.authorKauta, Ntambueen_ZA
dc.date.accessioned2017-09-06T07:07:30Z
dc.date.available2017-09-06T07:07:30Z
dc.date.issued2017en_ZA
dc.description.abstractIntroduction: Fragility fractures of the hip (FFH) constitute the most serious complication of osteoporosis carrying a mortality rate of up to 20 – 30% in the first year after injury and are associated with post injury decay in patient's level of activity in more than 50% of the cases. It is also a predictor of future osteoporosis related fractures. Surgical fixation of the hip fracture within 48 of admission, multimodal pain management, deep vein thrombo-prophylaxis, early physical therapy, appropriate assessment and management of osteoporosis and frailty in a multidisciplinary approach are the standard of care for FFH to keep the mortality and morbidity rate as low as possible and prevent future fragility fractures. Aim: To assess the standard of care of FFH at our institution and determine areas of care which need more attention and improvement. Methods: Retrospective review of clinical and radiographic records of all patients admitted at our level 1 trauma unit for fragility fracture of the hip from 1st January 2014 to 31st December 2014. The waiting time from admission to surgical fixation of the hip fracture, pain control and thrombo-prophylaxis strategies, the rate of geriatric referrals and the extent of osteoporosis management were assessed. Results: We admitted 113 fragility fractures of the hip from 1st January to 31st December 2014. Ninety- eight clinical records and 98 pelvis radiographs were included in the study. The other 15 clinical records were incomplete and were therefore excluded. The average waiting time from admission to surgery was 49 hours (range 9 -120). Low dose morphine, paracetamol and tramadol were the only perioperative pain control medication used for all patients. All patients had low molecular weight heparin and compression stockings prescribed for thrombo-prophylaxis. Only 2 (2, 04%) of patients had some osteoporosis investigations ordered. There were no geriatric referrals made and no formal osteoporosis management in all reviewed records. Conclusion: While the waiting time from admission to surgery was largely within the recommended time frame, there were no signs of a multidisciplinary approach to the management of fragility fractures of the hip at our institution leaving osteoporosis and frailty largely untreated.en_ZA
dc.identifier.apacitationKauta, N. (2017). <i>The management of fragility fractures of the hip: a quality assessment project</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Health and Rehabilitation Sciences. Retrieved from http://hdl.handle.net/11427/25067en_ZA
dc.identifier.chicagocitationKauta, Ntambue. <i>"The management of fragility fractures of the hip: a quality assessment project."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Health and Rehabilitation Sciences, 2017. http://hdl.handle.net/11427/25067en_ZA
dc.identifier.citationKauta, N. 2017. The management of fragility fractures of the hip: a quality assessment project. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Kauta, Ntambue AB - Introduction: Fragility fractures of the hip (FFH) constitute the most serious complication of osteoporosis carrying a mortality rate of up to 20 – 30% in the first year after injury and are associated with post injury decay in patient's level of activity in more than 50% of the cases. It is also a predictor of future osteoporosis related fractures. Surgical fixation of the hip fracture within 48 of admission, multimodal pain management, deep vein thrombo-prophylaxis, early physical therapy, appropriate assessment and management of osteoporosis and frailty in a multidisciplinary approach are the standard of care for FFH to keep the mortality and morbidity rate as low as possible and prevent future fragility fractures. Aim: To assess the standard of care of FFH at our institution and determine areas of care which need more attention and improvement. Methods: Retrospective review of clinical and radiographic records of all patients admitted at our level 1 trauma unit for fragility fracture of the hip from 1st January 2014 to 31st December 2014. The waiting time from admission to surgical fixation of the hip fracture, pain control and thrombo-prophylaxis strategies, the rate of geriatric referrals and the extent of osteoporosis management were assessed. Results: We admitted 113 fragility fractures of the hip from 1st January to 31st December 2014. Ninety- eight clinical records and 98 pelvis radiographs were included in the study. The other 15 clinical records were incomplete and were therefore excluded. The average waiting time from admission to surgery was 49 hours (range 9 -120). Low dose morphine, paracetamol and tramadol were the only perioperative pain control medication used for all patients. All patients had low molecular weight heparin and compression stockings prescribed for thrombo-prophylaxis. Only 2 (2, 04%) of patients had some osteoporosis investigations ordered. There were no geriatric referrals made and no formal osteoporosis management in all reviewed records. Conclusion: While the waiting time from admission to surgery was largely within the recommended time frame, there were no signs of a multidisciplinary approach to the management of fragility fractures of the hip at our institution leaving osteoporosis and frailty largely untreated. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - The management of fragility fractures of the hip: a quality assessment project TI - The management of fragility fractures of the hip: a quality assessment project UR - http://hdl.handle.net/11427/25067 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/25067
dc.identifier.vancouvercitationKauta N. The management of fragility fractures of the hip: a quality assessment project. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Health and Rehabilitation Sciences, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/25067en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Health and Rehabilitation Sciencesen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherOrthopaedic Surgeryen_ZA
dc.titleThe management of fragility fractures of the hip: a quality assessment projecten_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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