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Hip fractures and the brain

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About 65,000 people experience a hip fracture each year in the UK. This is the biggest single cause of major trauma and the cost represents about 1% of the NHS budget. Hip fractures are much commoner in older people and having a hip fracture is often a turning point in someone’s life.

As hip fractures happen suddenly, people are admitted to hospital urgently. They may be quite unwell with blood loss and dehydration. Often, after they have undergone surgery, they may have an episode of delirium. And sometimes, family members trace back the onset of their relative’s dementia to when they broke their hip and were in hospital.

We think that what happens with the brain in hip fractures is relatively neglected. We tend to concentrate on mending the broken bone, and on making sure that the person’s chest and heart are ready to cope with having the anaesthetic for their operation. The brain doesn’t get a look in. This is unfortunate, since the state of the brain is obviously really important in determining the subsequent outcome. If you are confused, it is harder to start walking again, so you may be discharged to a care home rather than your own.

When a person falls over, as well as breaking their hip, they are very likely to hit their head. This may cause a brief period of concussion but this is easily overlooked amongst other things that are going on, such as the pain and distress of the person who has fallen. Or the concussion resolves by the time the ambulance gets you to hospital, in which case no-one pays any attention. During the time before, during and immediately after surgery, there may be various other events that affect the brain, for example, if there is a lot of blood loss then the supply of oxygen to the brain may be reduced. Or there may be emboli – that is, small fatty particles dislodged from the fractured bone, passing into the circulation and reaching the brain. Or the person is still concussed from hitting the pavement hard.

Therefore, we think that the brain is being neglected in hip fractures, and we propose to do something about it. This could involve reviewing the research literature to see if other people have published about this issue but more importantly putting more emphasis on protecting the brain than currently happens. We have reason to believe this could make a big difference.

Jay Banerjee and Tom Dening, June 2018

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