Title : Medical challenges of hip fractures and how to manage

Hip fracture is a serious condition leading to increased mortality and many patients do not gain functional independence. Although the mainstay of treatment for hip fractures is orthoapedic repair, a multidisciplinary comanagement approach, including orthogeriatrician and rehabilitation, can reduce complications and maximize patient recovery .Older patients with fractures commonly have co-morbidities that require evaluation before and after surgery. Joint acute orthopaedic-geriatric units have been established to provide comprehensive orthopaedic and medical care. Recommendations surrounding the care of the older hip fracture patient includes early surgical fixation, the use of prophylactic antibiotics and thromboembolic prophylaxis, good perioperative pain control to improve ambulation, delirium detection and management to decrease the risk complications, the avoidance of malnutrition, urinary tract management, osteoporosis management and the promotion of early mobilisation to improve functional recovery. Physicians are well placed to manage these patients with orthopaedic surgeons during the perioperative period. Nearly 20% patients suffer postoperative medical complications. Multidisciplinary models incorporating these elements can reduce complications, mortality, and expedite hospital discharge. Sufficient evidence exists for most recommendations for fracture patients. In UK, The National Hip Fracture Database (NHFD), part of the Falls and Fragility Fracture Audit Programme (FFFAP) run by the Royal College of Physicians, uses information from every eligible hospital in UK every year to show how the right care and support can help to get people back onto their feet and leading a good quality life and is a benchmark for hospitals to compare their performances. Wecommenced an award winning Acute collaborative orthogeriatrician led Hip Unit in UK-first in Wales in a hospital. We have Published evidence this unit can reduce length of stay and improve care of hip fracture patients.

Dr Abhaya Gupta trained in India then moved abroad after his postgraduate MD degree. He has extensive experience of managing acute medical and elderly Medicine issues at hospitals in India, Middle East and UK. He  is currently  working as Consultant Medicine and Care of Elderly since last 22 years at a teaching hospital in United Kingdom. He is a teacher and trainer for junior doctors/ nursing and multidisciplinary team members,  examiner for Cardiff Medical School . He  has specialist expertise and experience in Acute Medicine and Orthogeriatrics. He  commenced  specialist osteoporosis service at UK hospital, had first patient on Injection Romosozumab in Wales. He was a pioneer at commencing Acute Collaborative Orthogeriatrician led Acute Hip Unit since 2011 for patients with Hip Fractures- first of its kind in Wales,UK  - a unique award winning service. He is Editorial Board member of ‘Geriatric Medicine’ , reviewer of ‘Age and Ageing’ journal and member of local specialist societies. He has published widely in several peer reviewed journals, presented his research as posters at several national and International meetings and conferences. He has published a book ‘Measurement scales in Elderly Medicine’. He is member of GOSI (Geriatric Orthopaedic Society of India) and has been a speaker at several international and GOSICON and GERICON conferences.