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Frailty and hip fracture optimisation — FRCA Final MCQ

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ModeratePerioperative MedicineFrailty and hip fracture optimisationFRCA Final

An 83-year-old man with Clinical Frailty Scale 6 is admitted with fractured neck of femur. He has mild delirium, chronic kidney disease and takes apixaban, last dose 20 hours ago. Surgery is clinically indicated once optimised. What is the most appropriate management?

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Correct answer: C — Coordinate early orthogeriatric optimisation, analgesia and time-critical surgery planning

Hip fracture care benefits from early multidisciplinary optimisation, effective analgesia and timely surgery, while managing anticoagulation and delirium risk. Frailty increases risk but is not a reason to withhold indicated surgery without shared decision-making. Intramuscular opioids worsen delirium and are poor analgesic practice. Anticoagulant timing should inform anaesthetic and surgical planning.

Reference: NICE CG124 hip fracture management; Association of Anaesthetists hip fracture guidance