7. Preventing the next fracture

11. "What anaesthetic do I need?" - with Iain Moppett

Welcome back to another special episode of The Rest Isn't Orthopaedics joined by Professor Iain Moppett, Professor of Anaesthesia and Perioperative Medicine. In this episode we tackle Grace's questions about anaesthesia and what type is right for her. We explain what nerve blocks are and why so many hip fracture patients receive them, explore how clinicians choose between general and regional anaesthesia, and finally touch on key points for recovery after surgery. Links: Anaesthetic Sprint audit of practice: https://www.nhfd.co.uk/20/hipfractureR.nsf/vwContent/asapReport [https://www.nhfd.co.uk/20/hipfractureR.nsf/vwContent/asapReport]Association of Anaesthetists; management of hip fracture guidelines 2020: https://anaesthetists.org/Guidelines-and-publications/Guidelines/Management-of-hip-fractures-2020 [https://anaesthetists.org/Guidelines-and-publications/Guidelines/Management-of-hip-fractures-2020] RAGA (reigonal vs general anaesthetic) trial: https://jamanetwork.com/journals/jama/fullarticle/2787494 [https://jamanetwork.com/journals/jama/fullarticle/2787494] Proffesor Johansen's Youtube channel: https://www.youtube.com/@antonyjohansen [https://www.youtube.com/@antonyjohansen]National Hip Fracture Database: https://www.nhfd.co.uk/ [https://www.nhfd.co.uk/]

10. "What operation do I need?" - with Matt Costa

Welcome back to a very special episode, joined by Matt Costa, surgeon and professor of orthopaedics in Oxford. We dive into Grace's questions about her operation, clarifying why surgery is so important and unpack the differences between intracapsular and extracapsular hip fractures and their management. We finish by touching on subtrochanteric fractures, and exploring some of Matt's pioneering research in the field. We hope you enjoy! Links: Hip fracture: https://pmc.ncbi.nlm.nih.gov/articles/PMC1488757/ [https://pmc.ncbi.nlm.nih.gov/articles/PMC1488757/ ] Hip fracture management NICE guidelines: https://www.nice.org.uk/guidance/cg124 [https://www.nice.org.uk/guidance/cg124] WHiTE 5 trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2108337 [https://www.nejm.org/doi/full/10.1056/NEJMoa2108337] WHiTE 11 trial: https://www.ndorms.ox.ac.uk/research/clinical-trials/current-trials-and-studies/fruiti [https://www.ndorms.ox.ac.uk/research/clinical-trials/current-trials-and-studies/fruiti] HEALTH trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1906190 [https://www.nejm.org/doi/full/10.1056/NEJMoa1906190] Cochrane evidence: https://www.cochrane.org/evidence/CD013405_which-are-best-treatments-hip-fractures-older-adults [https://www.cochrane.org/evidence/CD013405_which-are-best-treatments-hip-fractures-older-adults]

9. "Do I need an operation?"

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 [https://drive.google.com/file/d/1tEr5rQca1RJJ_jwa0FWwaYR1RYtIJlwX/view] Prof. Johansen's youtube channel, Hip fracture the : https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4Ez [https://www.youtube.com/playlist?list=PLH4P3rNfQEEswi7nEQQLTyyz7b2XVB4Ez]

8. Breaking the pain cycle; analgesia in hip fracture care

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 [https://www.youtube.com/@antonyjohansen] NHFD: https://www.nhfd.co.uk/ [https://www.nhfd.co.uk/]

7. Preventing the next fracture

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 [https://www.youtube.com/playlist?list=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/ [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/ [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/ [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 [https://www.nejm.org/doi/full/10.1056/NEJMoa074941] National Hip Fracture Database: ⁠https://www.nhfd.co.uk/⁠ [https://www.nhfd.co.uk/] Questions and suggestions? Email: Raihaan.Biju@wales.nhs.net [Raihaan.Biju@wales.nhs.net]