OGS Admission Criteria
Patients of any age with a minimal trauma femoral fracture requiring surgical intervention, including
- Fractured neck of femur (#NOF)
- Peri-prosthetic fracture of femur (these patients must be discussed with the orthopaedic registrar prior to admission)
- Distal femoral fracture
All patients with the fracture types listed above, who either have a diagnosis of osteoporosis or occur following minimal trauma (i.e. a low mechanism of injury should be considered for admission to OGS. There may be instances when young patients with a complex medical condition are selected for admission to the Orthopaedic Unit (with General Internal Medicine or other specialist Medical input as indicated). The orthopaedic registrar must discuss with the OGS geriatrician or the geriatrician on-call before any admission of young patients to the OGS.
Examples of OGS inappropriate admissions:
- Unconfirmed fractures
- Non-femoral fractures
OGS After Hours Admission Checklist – http://www.whod.com.au/wp-content/uploads/2024/01/OGS_afterhours_admissionguide_2024-8.pdf
Pain Management
Fascia Iliaca block (FI block) should be performed on all patients in ED
Pre-operative Investigations
All patients with femoral fractures should have:
- FBE, UEC, Coagulation studies, Group and Hold
- Chest XR
- ECG
Patients with subcapital NOF fractures should have an AP pelvis XR with a templating marker
This templating marker must be completely in the field of view and the XR should be without significant rotation of the pelvis or femur on the non-operative side.
Patients who are being considered for a long intramedullary nail (IMN) should have a full-length femur XR pre-operatively
OGS bloods
Additional bloods that should be ordered for OGS patients include
- Calcium, magnesium, phosphate
- Thyroid function tests
- Iron studies, B12, Folate
- Vitamin D
Bowel / Bladder Management
TDS bladder scans
IDC if PVR >….
All patients should be charted for regular aperients unless contra-indicated
Sip to Send / Fasting plans
DVT Prophylaxis
- Prophylactic dose enoxaparin should be prescribed for 28 days post-op for ALL patients with hip fracture except:
- Patients who have been recommenced on their usual anticoagulation (eg. Warfarin for mechanical MVR).
- Patients with a relative contraindication to enoxaparin. – See section 8.2.3.1 Pharmacological VTE Prophylaxis Relative Contraindications from the Adult Venous Thromboembolism Prevention PPG on intranet
- Unacceptable risk of falls, as determined by treating geriatrician.
- Prophylactic enoxaparin should be charted daily at 2000. On the day of surgery enoxaparin should be administered at 2000 or at least 6 hours post-operatively, unless advised otherwise by orthopaedic surgeon due to concerns about bleeding.
- If prophylactic enoxaparin is withheld, the patient must be placed on intermittent pneumatic calf compressors. Use of TEDS can be considered, but is often contraindicated in patients with hip fracture due to poor skin integrity
- See Guidelines for further information
Standard of Care
External Links
Australian Commission on Safety and Quality in Health Care – Hip Fracture Standard of Care 2023
Authors / Stakeholders
- OGS
- Dan Sydenham
- Ann Williams (access to care to organise trauma lists and in hours trauma)
- NOF committee
- Lily Salehi