External podcast series – Hip fracture: The rest isn't orthopaedics
Hosted by Dr Raihaan Biju and Professor Antony Johansen, 'Hip Fracture: The Rest Isn't Orthopaedics' explores the care of older patients through the lens of hip fracture management. Aimed at the whole healthcare team—nurses, physios, OTs, medics, surgeons, and students—we cover key topics including frailty, acute care, pain relief, delirium, and nutrition. Designed to be practical, concise, and relevant for the whole MDT.
Trailer
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. Designed for the whole MDT, this series makes complex topics simple, practical, and relevant for everyone.
1. A model for multi-discplinary care
In this episode, hip fracture care is used as a lens to explore the wider challenges of caring for frail and older patients in hospital. What can hip fracture care teach us about treating older adults more holistically?
2. The fracture or the frailty
Hip fractures are one of the most common reasons older adults come into hospital — but how dangerous is hip fracture surgery really? This episode goes beyond the operation to explore what frailty means, how it shapes outcomes, and why managing it is often more challenging than fixing the bone. I looks at comprehensive geriatric assessment and unpacks the core pillars of acute hip fracture care — Haemorrhage, Immobility, and Pain (HIP) — showing how each can make or break recovery.
3. Delirium; clarifying confusion
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, it explores how the whole team — from doctors to nurses to families — can reduce the burden of this hidden complication.
4. Step by step; rethinking rehabiliation
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. This episode explores why early mobilisation matters, the barriers that can get in the way, and how the best hospitals anticipate and overcome them. Featuring 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.
5. Feeding recovery; the importance of nutrition
Nutrition is often the missing piece in hip fracture recovery — yet it can mean the difference between regaining independence or facing decline. This episode looks at the evidence behind nutrition, or lack thereof, as well as ward-based strategies such as red trays and dietetic assistants.
6. The tipping point; preventing falls
Preventing the next fall is just as important as treating the consequences of the first. A look at why older adults fall, the major risk factors, and the strength of the evidence behind different interventions.
7. Preventing the next fracture
This episode explores 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.
8. Breaking the pain cycle; analgesia in hip fracture care
This episode explores 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. More effective strategies are discussed – 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.
9. "Do I need an operation?"
This episode explores the legal and ethical aspects of consent, discusses non-operative management options, and looks at how approaches differ across healthcare systems.
10. "What operation do I need?" - with Matt Costa
This epidode clarifies why surgery is so important and unpacks the differences between intracapsular and extracapsular hip fractures and their management. It also features subtrochanteric fractures, and exploring some of Matt's pioneering research in the field.