Early mobilisation surgical management of fracture neck of femur

Dr Catherine Said1, Ms Vera Ciavarella1, Ms Marisa Delahunt1, A/Prof  Sue Berney1

1Austin Health, Heidelberg, Australia

Aim: Guidelines for management of fracture neck of femur (NOF) include the importance of early mobilisation post surgery. Aims of the audit were to determine proportion of people who mobilise within 48 hours, barriers to mobilisation and incidence of post-operative delirium in patients undergoing surgical fixation of fractured NOF.

Method: Prospective audit of patients admitted to the orthopaedic ward over the age of 18 with fractured NOF. The outcomes of interest included proportion of people mobilising within 48 hours post-operatively, barriers to mobilisation if mobilisation did not occur and incidence of delirium.

Results: Data were collected from 100 participants (age 82 ± 9 years; 81 ambulant independently +/- gait aid premorbidly); 46% mobilised within 2 days post surgery.  Barriers to mobilisation day 1 or day 2 respectively included confusion or drowsiness (18%, 10%), pain (7%, 1%), participant declined (11%, 10%), medical issues (16%, 14%), manual handling risk (12%, 12%).  Only two people who needed assistance to ambulate premorbidly mobilised within 2 days post-surgery.  Delirium was likely present in 32 participants day 1 and 28 on day 2.

Significance of the findings to allied health: Over half of the people who had surgical management of a fractured NOF did not mobilise within 48 hours and nearly a third of the group had delirium in the first 48 hours.  Barriers to mobilisation should be explored to determine whether they can be minimised.  Novel methods of encouraging activity in this at risk group should be explored.