Orthogeriatrics

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LogoKeyPointsBox.pngPrinciples of good orthogeriatric care:
  • Prompt delivery of appropriate care
  • Rapid comprehensive assessment – medical, surgical and anaesthetic
  • Minimal delay to surgery if indicated
  • Appropriate surgical and anaesthetic technique
  • Appropriate management of comorbidities and complications
  • Prompt mobilisation
  • Early multidisciplinary rehabilitation
  • Early supported discharge and ongoing community rehabilitation
  • Secondary prevention, combining bone protection and falls assessment

Orthogeriatrics is a sub-speciality area that originally developed from liaison services with orthopaedic and trauma services. It may involve coordinating management of elderly fallers, now often a service in its own right, as well as involvement in the acute and rehabilitative care of elderly patients presenting with serious trauma, such as fractured neck of femur. This area of interest developed as a result of concerns with regard to outcome after particularly fracture neck of femur with traditional models of orthopaedic care. Work in Hastings suggested one effective model was the orthogeriatric unit, with input from both a consultant orthopaedic surgeon and geriatrician with an interest. This model has not subsequently been shown to be better than best alternative care delivered by different routes, but has been shown conclusively to be better than the fix it and discharge to anywhere approach. Successful models of orthogeriatric care have always taken an integrated approach to the healthcare challenges involved and wide experience worldwide has shown that unintegrated compartmentalisation of care delivery consistently results in poorer overall outcome.


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