Hello everyone and welcome back to Season 2! We’re launching a three-part mini-series starting with an episode on the consent process — and how to respond when Grace asks, “Do I need an operation?” We explore the legal and ethical aspects of consent, discuss non-operative management options, and look at how approaches differ across healthcare systems. We finish by unpacking the four ethical principles and how they're relevant to Grace. Hope you enjoy listening!
Links:
Multilingual patient information leaflet resource: https://drive.google.com/file/d/1tEr5rQca1RJJ_jwa0FWwaYR1RYtIJlwX/view
Prof. Johansen's youtube channel, Hip fracture the : https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4Ez
Hello everyone, and welcome back to our second season of The Rest Isn’t Orthopaedics! In this episode, we dive into the challenge of managing pain for Grace, our model hip fracture patient. We explore why the traditional WHO pain ladder no longer meets the needs of patients in this setting and how its stepwise approach can leave people under‑treated and distressed.
Instead, we discuss more effective strategies – including timely opioids, iliac fascia nerve blocks, and personalised post‑operative plans – that reduce complications, improve comfort, and support recovery. By rethinking how we approach pain, we can make a real difference to patient outcomes and experiences.
Links:
Proffesor Johansen's Youtube Channel: https://www.youtube.com/@antonyjohansen
NHFD: https://www.nhfd.co.uk/
We’re almost ready to send Grace home! But if she does fall again, how can we prevent another fracture? In the final episode of our first season, we explore the key trials that have shaped our approach to bone health — from calcium and vitamin D to bisphosphonates such as alendronate, and finally zoledronate. We unpack the benefits and challenges of these treatments, and reflect on why bone protection is so important for the whole multidisciplinary team. Join us as we wrap up Season 1, bringing together everything we’ve learned about improving outcomes for patients like Grace.
Links:
‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlistlist=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4Ez
Patient level pooled analysis of 68,500 patients from seven major vitamin D fracture trials in US and Europe: Abrahamsen et al. BMJ 2010 https://pubmed.ncbi.nlm.nih.gov/20068257/
Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people: a randomised placebo-controlled trial: The RECORD Trial Group. Lancet 2005 https://pubmed.ncbi.nlm.nih.gov/15885294/
Randomised trial of alendronate on risk of fracture in women with existing vertebral fractures: Fracture Intervention Trial Research Group. Lancet 1996 https://pubmed.ncbi.nlm.nih.gov/8950879/
Zoledronic acid, clinical fractures and mortality after hip fracture: Lyles et al. NEMJ 2007. https://www.nejm.org/doi/full/10.1056/NEJMoa074941
National Hip Fracture Database: https://www.nhfd.co.uk/
Questions and suggestions? Email: Raihaan.Biju@wales.nhs.net
Hip fractures are the commonest reason for older adults to be admitted to hospital for emergency surgery — but the rest of their care isn’t about orthopaedics. Behind each fracture may lie frailty and a need for coordinated multidisciplinary teamwork. In this episode, we use hip fracture care as a lens to explore the wider challenges of caring for frail and older patients in hospital. From the early days of surgical defeatism to today’s orthogeriatric-led models and national audit, we ask: what can hip fracture care teach us about treatingolder adults more holistically?
Links:
‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4Ez
NICE Guideline: https://www.nice.org.uk/guidance/cg124
National Hip Fracture Database (NHFD): https://www.nhfd.co.uk/
BOA-BGS Blue Book: https://www.bgs.org.uk/sites/default/files/content/attachment/2018-05-02/Blue%20Book%20on%20fragility%20fracture%20care.pdf
Hip fractures in the elderly: a world-wide projection: Cooper et al. Osteoporosis Int. 1992. https://pubmed.ncbi.nlm.nih.gov/1421796/
Geriatric Orthopaedics. Devas BMJ 1974. https://www.bmj.com/content/1/5900/190
Effectiveness of geriatric rehabilitation after proximal femur fracture in the elderly: Kennie et al. BMJ 1988. https://pmc.ncbi.nlm.nih.gov/articles/PMC1834847/
Prospective randomised study of an orthopaedic geriatric in-patient service: Gilchrist et al. BMJ 1988. https://pubmed.ncbi.nlm.nih.gov/3143450/
Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures: Cameron et al. Cochrane Database 2001 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000106/references
Questions and suggestions?
Email: Raihaan.Biju@wales.nhs.net
Welcome to Hip Fracture: The Rest Isn’t Orthopaedics! Dr. Raihaan Biju introduces season 1, which covers key medical topics — all viewed through the journey of a hip fracture patient.
From acute care and delirium, nutrition, rehab, and preventing future falls and fractures, we break down the essentials of hospital care. Designed for the whole MDT, this series makes complex topics simple, practical, and relevant for everyone.
In today’s episode, we return to Grace’s story, which began with a fall. Preventing the next fall is just as important as treating the consequences of the first. We look at why older adults fall, the major risk factors, and the strength of the evidence behind different interventions. Along the way, we discuss the key tests used to investigate falls and why they matter. Finally, we highlight the vital role of the multidisciplinary team in carrying out a comprehensive geriatric assessment, ensuring coordinated, patient-centred care that helps keep patients like Grace safe and independent.
Links:
‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4Ez
NICE Guidance Falls: https://www.nice.org.uk/guidance/ng249
Interventions for preventing falls in older people living in the community. Cochrane Database. https://www.cochrane.org/evidence/CD005465_interventions-preventing-falls-older-people-care-facilities-and-hospitals
Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Harwood et al. Br J Ophth. 2005 https://pubmed.ncbi.nlm.nih.gov/15615747/
A multicentre randomised controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls. Age Ageing. 2010 https://pubmed.ncbi.nlm.nih.gov/20823124/
Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls. Irvine L et al. Age Ageing. 2010 https://pubmed.ncbi.nlm.nih.gov/20833862/
Multifactorial assessment and targeted intervention forpreventing falls and injuries among older people in community and emergencycare settings: systematic review and meta-analysis. Gates et al. BMJ 2008. https://pubmed.ncbi.nlm.nih.gov/18089892/
Screening and intervention to prevent falls and fractures in older people. Lamb et al. N Engl J Med. 2020;383(19):1848-1859. https://www.nejm.org/doi/full/10.1056/NEJMoa2001500
Questions and suggestions? Email: Raihaan.Biju@wales.nhs.net
Nutrition is often the missing piece in hip fracture recovery — yet it can mean the difference between regaining independence or facing decline. In this episode, we unpack the evidence behind nutrition, or lack thereof, as well as ward-based strategies such as red trays and dietetic assistants. We also highlight the vital role family members play. Drawing on both research and real-world practice, we show why nutrition isn’t just supportive care, but a frontline therapy where families and healthcare teams must work hand in hand.
Links:
‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4Ez
Frailty in older adults: evidence for a phenotype: Fried et al. J Gerontol A Biol Sci Med Sci. 2001 https://pubmed.ncbi.nlm.nih.gov/11253156/
Nutritional supplementation for hip fracture aftercare in older people. Avenall et al. Cochrane Database Syst Rev. 2016 Nov 30;11(11):CD001880, https://www.cochrane.org/evidence/CD001880_nutritional-supplementation-older-people-after-hip-fracture
Reducing nutritional risk in hospital; the red tray: Bradley et al. Nursing Standard 2003 https://pubmed.ncbi.nlm.nih.gov/12677818/
Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward: Duncan, Hood, Beck, Johansen, Age Ageing 2006; 35:148-153, https://doi.org/10.1093/ageing/afj011
Questions and suggestions? Email: Raihaan.Biju@wales.nhs.net
Bed rest is no longer an option after hip fracture. Evidence shows that getting patients out of bed the day after surgery is one of the most powerful predictors of recovery. In this episode, we explore why early mobilisation matters, the barriers that can get in the way, and how the best hospitals anticipate and overcome them. We shine a spotlight on the crucial role physiotherapists play — helping patients take those first steps — alongside the wider multidisciplinary team and families who support the journey back to independence.
Links:
‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4Ez
KPI 3, from the NFHD: https://www.nhfd.co.uk/20/NHFDcharts.nsf/vwcharts/KPI3-NICEcompliance?open
KPI 4, from the NFHD: https://www.nhfd.co.uk/20/NHFDcharts.nsf/vwcharts/KPI4-Promptlyoutofbed?open
NICE Guidance on Hip Fractures: https://www.nice.org.uk/guidance/cg124/update/CG124/documents/hip-fracture-draft-nice-guideline2
HipSprint (Physio) Outcomes: https://www.csp.org.uk/professional-clinical/improvement-innovation/hip-fracture-rehab/hip-sprint-local-audit
The REDUCE Study. Bristol University. https://www.bristol.ac.uk/translational-health-sciences/research/musculoskeletal/rheumatology/research/hip-fractures/
Questions and suggestions? Email: Raihaan.Biju@wales.nhs.net
In today's episode we follow Grace, who seems confused despite a successful hip surgery. This episode unpacks the difference between dementia and delirium; why delirium matters so much in hip fracture care, and what the evidence shows we can do to prevent it. With practical bedside tips and strategies, we explore how the whole team — from doctors to nurses to families — can reduce the burden of this hidden complication.
Links:
‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4Ez
4A Test: https://www.the4at.com/
Reducing delirium after hip fracture: a randomized trial: Marcantonio et al. J Am Geriatr Soc 2001, https://doi.org/10.1046/j.1532-5415.2001.49108.x
Questions and suggestions?
Email: Raihaan.Biju@wales.nhs.net
Hip fractures are one of the most common reasons older adults come into hospital — but how dangerous is hip fracture surgery really? In this episode, we go beyond the operation to explore what frailty means, how it shapes outcomes, and why managing it is often more challenging than fixing the bone. We dive into the comprehensive geriatric assessment and unpack the core pillars of acute hip fracture care — Haemorrhage, Immobility, and Pain (HIP) — showing how each can make or break recovery. Along the way, we highlight the lessons hip fracture care offers for treating older patients more holistically, and why multidisciplinary teamwork is essential for better outcomes.
Links:
‘Hip Fracture – the Cardiff approach’ on YouTube: https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4Ez
NFHD: https://www.nhfd.co.uk/
Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database: Johansen et al. Anaesthesia 2017 https://doi.org/10.1111/anae.13908
Krishnan M, Beck S, Havelock W, Eeles E, Hubbard R, Johansen A. Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results Age Ageing 2013 https://academic.oup.com/ageing/article-abstract/43/1/122/23338?redirectedFrom=fulltext
Questions and suggestions? Email: Raihaan.Biju@wales.nhs.net
