Acute orthogeriatric care in the peri-operative period

The management of the older person with a fracture is becoming increasingly complex. There is an epidemic of hip fractures with increasing numbers of very frail elderly patients being admitted and requiring surgery. Medical and ethical dilemmas abound in this age group making it essential that systems of orthogeriatric care are developed so that appropriate expertise in managing these problems is readily available in the perioperative period. There is a lack of quality research involving this type of population and evaluating different models of care. Delays to theatre should be avoided if the patient is medically fit. This article focuses on a number of difficult and contentious cases in orthogeriatric care involving the management of troponin rises, murmurs, do not resuscitate orders in the peri-operative period and atrial fibrillation.