GUH Ward rounds

Grange University Hospital - Ward Round Mr Andrew Miller MD BSc MB BCh MSc FRCS (Orth) Consultant Trauma & Orthopaedic Surgeon Hips, Knees and Pelvic Reconstruction Patient Name: John Smith Date of Birth: 12/03/1958 Patient ID: 1234567 Location: Ward A, Bed 12 Diagnosis: - Right Femoral Neck Fracture - Osteoarthritis - Hypertension Mechanism of Injury: Patient fell at home, sustaining a fall onto his right hip. Date of Injury: 31 October 2024 Symptoms: Mr Smith reports severe pain in his right hip, exacerbated by movement. He is unable to weight bear. He also reports some stiffness in his left knee. PMHx: - Hypertension, Osteoarthritis - Right Total Hip Replacement (2015), Left Knee Arthroscopy (2018) - Ramipril 2.5mg daily, Paracetamol 1g QID, Aspirin 75mg OD - Penicillin Examination: On examination, the patient is in significant pain. There is obvious shortening and external rotation of the right leg. There is tenderness to palpation over the right hip. Neurovascular examination of the right lower limb is intact. The left knee has mild effusion and crepitus. Investigations: X-ray of the right hip confirms a displaced femoral neck fracture. Blood tests are within normal limits. Discussion: Discussed the findings with the patient and explained the need for surgery. The patient understands the risks and benefits and has consented to proceed. Plan: - Immediate plan: Patient to undergo right hip hemiarthroplasty tomorrow. Analgesia to be optimised. - Contingency Plan if Primary Plan is not Successful: If hemiarthroplasty is not suitable, consider total hip replacement. - Additional Imaging or Tests Required: Pre-operative bloods and ECG completed. Further imaging not required. - Referral to Specialist if Required: N/A - Follow-Up Plan: Review post-operatively. Physiotherapy to commence as per protocol. Patient seen today despite unacceptable risk of morbidity and mortality. Restrictive resource allocation continues to adversely affect patient outcomes.