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  Hip Fracture in Elderly Dr. Zolqarnain Bin Ahmad  
Dr. Zolqarnain Bin Ahmad
A hip fracture may result in a loss of physical function, decreased social engagement, increased dependence, and worse quality of life. It can be a life-threatening illness for elderly patient. Death after a hip fracture may also be related to additional complications of the fracture, such as infections, internal bleeding, stroke, or heart failure.
Reasons/ Causes/ Risk Factors & Complication  

Reasons/ Causes/ Risk Factors & ComplicationHip Fracture in Elderly

  • Many hip fractures occur from injures such as a fall.
  • Osteoporosis is one condition that causes hip fractures.
  • Elderly with weak bones, a hip fracture can occur simply by standing on the leg or sitting down.
  • Age is a key risk factor, with hip fractures more likely to occur in those aged 65 or older.
  • 1 in 3 adults aged 50 and over dies within 12 months of suffering a hip fracture.
  • Older adults have a 5 - 8 times higher risk of dying within the first 3 months of a hip fracture compared to those without a hip fracture.
  • Research shown around 30% of people with hip fractures have had a prior fracture; this is known as the “fracture cascade”.

Some of the more common problems that a hip fracture can increase the likelihood of include:
  • Pneumonia
  • Bed sores (pressure ulcers)
  • Deep Vein Thrombosis (DVT) – blood clots in the large veins of the leg
  • Mental confusion
Treatment Option & Doctor Perception  

Treatment Option & Doctor Perception

The goal of any hip fracture surgery is to hold the broken bones securely in position, allowing the patient to get out of bed as soon as possible. Hip fractures in the elderly are usually treated with surgery to fix the fractured bones after proper assessment, it is normally done within 24 hours of admission to the hospital.
Most hip fractures are treated in one of three ways: with metal pins, a metal plate and screws, or with artificial replacement of the broken femoral head. Upon consulting, doctor will evaluate the risk and urgency of the patient’s condition.
Some cases of hip fractures would actually heal without surgery involved, but it will take 8 – 12 weeks for patient to recover. However, placing an elderly person in bed for a long period of time may results in greater risk of creating serious complications than the surgery. This is the reason surgery is recommended to nearly all patients with fractured hips.
Prevention & Rehabilitation  

Prevention & Rehabilitation

How do we prevent hip fractures and taking care of your bones?
  • Do strength and balance exercises to strengthen your muscle and bones
  •  Ensure your home is safe for elderly, getting eye exam to protect your vision
  • Consult a doctor to evaluate your risk and review medicines
  • Get an Osteoporosis screening / bone density test
Rehabilitation After a Hip Fracture  

Rehabilitation After a Hip Fracture

Most patients are able to start weight bearing right away after surgery. Depending on the severity of the fracture, patients may only be able to place partial weight down right away. To speed up the recovery, therapeutic rehabilitation will be involved. Physical therapy may be needed for patients who have problems walking.
  Enterovirus Infection Dr. Choong Choun Seng
DR Choong Choun Seng
Malaysia is like summer all the year round. Major and minor epidemiological cases of enteroviruses occur every month. With the peak from March to June, the symptoms are mostly manifested by Herpangina and Hand, Foot, and Mouth Disease (HFMD). Most of the enterovirus infections are mild and will recover after a certain course of disease. This type of virus infection is mainly caused by the Coxsackie virus. The few types that can cause severe illness or even death are mainly enterovirus type 71.

Clinical manifestations:

  • Mainly caused by the Coxsackie A virus.
  • Characteristics: Sudden on set of high fever, sore throat and vomiting, blisters or ulcers in the pharynx, inability to eat, and some require hospitalization and intravenous therapy. The course of the disease is 4-6 days.
  • Mainly affects children 1-7 years old. The main route of infection is fecal-oral or respiratory tract.
  • Key prevention method: Wash your hands frequently.
 Hand, Foot, and Mouth Disease (HFMD)
  • The most common causes of the virus are Coxsackie A, B virus and enterovirus type 71.
  • Characteristics: Fever, small blisters
  • Mainly distributed in oral mucosa and tongue, followed by soft palate, teeth, and lips. The blisters over the limbs consist of the palms and soles of the feet or in between the fingers and toes. Occasionally, there are small blisters on the butt, knees, and elbows. Some blisters are itchy, and the general course of the disease is about seven days.
Infant acute Myocarditis
  • Mostly caused by Coxsackie virus type B and Enterovirus Type 71
  • Characteristics: Sudden breathing difficulties, pallor, fever, vomiting, followed by rapid heartbeat, heart failure and shock, and even death.
  • If your children have the symptoms of poor activity, continuous vomiting, rapid heartbeat (Tachycardia), and Myoclonic Jerk, please send them to the hospital immediately.
  Dengue Dr. Chew Ray Ming  
Dr. Zolqarnain Bin Ahmad

What you need to know about dengue?

Dengue is a very common disease in Malaysia that occurs as a result of the bite of a disease carrying mosquito called Aedes. This mosquito typically comes out to feed at dawn and dusk.

After being infected, the disease symptoms typically range from dengue fever (DF) that heals by itself, to dengue haemorrhagic fever (DHF) and DHF with shock syndrome (this means one’ll be very sick and MUST be admitted, as this is potential life-threatening). The risk of severe disease is much higher if one gets dengue a second time than the first.
  Dengue | Aedes
Classical DF is a newly occurring fever accompanied by headache, pain behind one’s eye balls & marked muscle and bone pains. Fever lasts typically for 5 to 7 days, during which at this time one’s platelet (the component of the blood that’s used for stopping a bleed from a wound) will be low & with or without the typical rash (what doctors call “Isles of white in a sea of red”).
Isle’s of white
Background sea of red
  DHF is the most serious manifestation of dengue infection and plasma leakage (fluid that escapes from the cells into other bodily spaces such as lungs and stomach) is the most life-threatening feature of DHF. This usually occurs over a period of 24 to 48 hours AFTER fever has subsided (Yes, NOT DURING fever). Haemorrhagic manifestation in DHF can range from spontaneous petechiae (like the red rash in the picture) or profuse bleeding (e.g., like throwing up blood).
The diagnosis of DF is based on signs and symptoms in individuals exposed to dengue (in Malaysia, while some places are labelled as “black dengue areas”, literally EVERYWHERE is dengue prevalent). A simple blood test at a hospital (and certain clinics) will be able to help doctors confirm DF.

Typically, we advise the public to come see a doctor the moment you have a fever lasting at or beyond 3 days. But we strongly advise medical attention if one has any dengue warning signs (regardless of number of fever days), which are:
  • Abdominal pain
  • Persistent vomiting
  • Any bleeding (e.g., gum bleed, bruises, or vomiting blood)
  • Restlessness or excessive lethargy
  • Difficulty breathing, leg/hand/facial swelling or severe loss of appetite (due to fluid accumulation in the designated parts of the body)
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