1. Which Strategy to Europe?
Hip Fractures
Which Strategy to Europe?
Paulo Felicíssimo

2. Topics 1- Introduction 2- Why is important? 3- Incidence 3- Challenges
4- Clinical Pathway
5- Discharge Program
6- Conclusions

3. Nota para conversão:
_____ng/ml • 2.5 = ______nmol/L
_____µg/dia • 40 = UI/dia

4. Hip Fractures

5. Why is Important?
… de forma a padronizar a nossa actuação!

6. 4ª feira –

7. This is a picture of my department…I spend most of time is with these girls!!!

8. Hip Fractures World Prevision
1,6 Millions in 2000
2,6 Millions in 2025
it is supposed1,6 millions of fractures in 2000…..And it is expected 2,6 millions in 2025 , and probably 4,5 millions !
4,5 Millions
In 2050
Johnell O, Kanis JA, Osteoporos Int. 2006;17:

13. …and gonna be worse!!!!
… de forma a padronizar a nossa actuação!

14. Growth of population

16. Growth of life expectancy

17. Population aging

19. Hip Fracture Challenges
Medical Challenge
Orthopedic Challenge
Social / Familiar Challenge
Economic Challenge
Organizational Challenge
Como em muitas outras áreas da Medicina as fracturas da extremidade proximal do fémur são um verdadeiro desafio….pluridisciplinar!

20. The fracture is the drop of water in a full glass

21. The Patient with a Fracture that has Diseases
The Patient with a Fracture that has Diseases???? or The Patient with Diseases that have a fracture????
…nós somos habitualmente o fim da linha! Quando recebemos um doente

22. Are Orthopedic Departments prepared to Treat these Patients?
… de forma a padronizar a nossa actuação!

23. No!!!
Internal Medecine
We try to know the opinion of the partners in this war

24. No!!!
We try to know the opinion of the partners in this war
Anesthesiology

25. No!!!
Orthopedic Nurses

26. …Yes!!!! and No!!!…and it's their fault!!!

27. …No!!!!…

28. No!!!

29. Organizational Model Insufficient Not adjust ... Clinically Bad!
... Economically Bad!
Diagnostic delay
Therapeutic delay
Higher mortality
…existe pois uma opinião quase consensual…
More Diagnosis Tests
Discharge Delay

30. Solution?
…nós somos habitualmente o fim da linha! Quando recebemos um doente

32. Multidisciplinar Team
Orthopedic Surgeon
Internal Medicine
Anesthesiology
Physical Medicine and Rehabilitation
Physiotherapy
Nurse
Social support
Nutritionist
Pharmaceutics

33. Organizational Model Multidisciplinary
Teams!!!!! Clinical Pathway with Therapeutics Protocols!!!

34. «Clinical pathway» Hip Fractures
Dia
Emergence Room
Analgesic Protocol
VTE prophylaxis
Geriatrics/Internal Medicine
Medical evaluation
0- 2
Surgery
Analgesic Protocol
Timing of Surgery!
Surgical Decision?
Fracture Personality
Parker and Parker scale
Charlson comorbidity Scale
VTE prophylaxis
AB prophylaxis
Anemia Protocol
Avaliação
Physiotherapy
Protocolo Exames Complementares
Nutrition Protocol
5- 7
Delirium Protocol
Discharge

35. Is this enough?
… de forma a padronizar a nossa actuação!

36. Previous Physical Function
Hip Fractures
15% of patients recover
Previous Physical Function
Mortality 20% to 30%
In the first year
40% of patients
severe disability

37. After a Hip Fracture 10,4 / 100 Patients/ year 1
Incidence of new Osteoporotic Fracture is:
10,4 / 100 Patients/ year 1
2,5 X Superior to population with similar characteristics, without previous fracture 1
1 – Colón-Emeric C et al. The contribution of hip fractureto risk of subsequent fracture:data from two longitudinal studies. Osteoporos Int. 2003;14:

42. What to do?

43. We can try not to see

44. We can hope that the obvious do not happen.

45. Nothing to do because is a superior punish

46. …or just give a little help

47. Discharge Program!!!
… de forma a padronizar a nossa actuação!

48. Discharge Program - Hip Fractures
Dia
Emergence Room
Movement Medicine
Fall Prevention
0- 2
Surgery
Fracture Prevention Program
Osteoporosis treatment
Nutritional Protocol
Physiotherapy GP
Anemia Protocol
Avaliação
VTE prophylaxis
Schedule Next appointment and X-ray
5- 7
Discharge
Schedule Surgical Dressing

49. Conclusions
A Clinical Hospital Team organized in turn of a «Clinical Pathway» is the right answer for a success and management of resources
It have to be a Multidisciplinary Team «speaking the same language»
Discharge Program with GP in close participation
Podem estar muito bem operados … mas se morrerem pouca vantagem existe!!!

50. ...all of this for a good physical and mental health of our old ladies.