ABSTRACT
This chapter presents a case study of a 90-year-old woman who cannot stand and has been brought in the Emergency Department complaining of pain in her right hip. This lady has a right neck of femur fracture. The initial management of this patient should follow standard trauma guidelines. Assessment should start with a top-down approach and medical students and junior doctors should assess for concurrent head and neck injury. This woman is noted to be in atrial fibrillation with a rapid ventricular rate and has a low-grade fever. Most hospitals have a dedicated care pathway for elderly patients with hip fractures. It provides a standardised care bundle with specific goals including timely initial analgesia, radiographs, a checklist of blood investigations, urinary catheter insertion, skin checks, pressure-relieving mattresses, post-operative thromboprophylaxis and rehabilitation goals. Operative decision-making needs to consider the premorbid status of the patient and their ability to cope with the stress of anaesthesia as well as the individual fracture pattern.
