Medical / Surgical Management of Hip Fractures NEBGEC Frail Elderly and Geriatric Syndromes July 16-17, 2009 Chad W. Vokoun, M.D., FACP Assistant Professor Associate Program Director Department of Internal Medicine University of Nebraska Medical Center
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Medical / Surgical Management of Hip Fractures
NEBGEC Frail Elderly and Geriatric SyndromesJuly 16-17, 2009
Chad W. Vokoun, M.D., FACPAssistant Professor
Associate Program DirectorDepartment of Internal Medicine
University of Nebraska Medical Center
• I have no commercial or financial conflicts of interest to disclose.
Case
• 87 y.o. female presents following a fall while getting out of a car this morning. She arrived by squad and has been evaluated by the ED staff. X-rays show a minimally displaced femoral neck fracture. Her history is significant for DMII, CAD (MI four years ago –medical management), and HTN. She lives independently but receives help with day to day activities from her daughter who lives nearby
References• Rao, SS, Cherukuri, M. Management of Hip Fracture: The Family Physician’s Role. American
Family Physician 2006; 73(12) 2195-2200.• Hip Fractures Among Older Adults. CDC.gov factsheets• Haleem S. Mortality following hip fracture: trends and geographical variations over the last
40 years. Injury 2008; 39(10) 1157-63.• Medical consultation for patients with hip fractures. UpToDate.• Conservative Versus Operative Treatment for Hip Fractures in Adults, Cochrane Review 2009• Ja ̈rvinen, T. Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 2008;
336, 124-126.• Medocina TMS, et al. Evaluation of the health-related quality of life in elderly patients
according to the type of hip fracture: femoral neck or trochanteric. Clinics 2008;63(5) 607-612.
• ACC / AHA guidelines for preoperative risk assesment• AACE / ADA consensus statement on inpatient treatment of hyperglycemia
References• Douglas, CB, et al. Perioperative diabetic and hyperglycemic management issues. Critical Care
Medicine 2004; 32S:116-125.• American College of Endocrinology Position Statement on inpatient Diabetes and Metabolic
Control. Endocrine Practice 2004; 10: 77-82.• Hoogwerf, BJ. Perioperative management of diabetes mellitus. Cleveland Clinic Journal of
Medicine 2006; 73: s95-s99.• Van Den Berghe, G, et al. Intensive insulin therapy in critically ill patients. New England
Journal of Medicine, 2001; 345:1359-1367.• Moritoki, E, et al. Intensive insulin therapy in postoperative intensive care unit patients.
American Journal of Respiratory Critical Care Medicine, 2006; 173:407-413.• Furnary, AP. Continuous insulin infusion reduces mortality in patients with diabetes
• Gore, DC. Association of hyperglycemia with increased mortality after severe burn injury. Journal of Trauma, 2001;51:540-544.
• Malmberg, K. Prospective randomized study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. British Medical Journal, 1997;314:1512