Hip fracture

It is quite common to hear from your friends or within your own family that an elderly person has fallen down and had a hip fracture. This fracture occurs due to a break in the hipbone, usually the upper part of the thighbone (femur). The incidence of such fractures increases with age, with about ninety percent of broken hip cases seen in people aged over 50 years, while nine out of ten are seen in senior citizens (older than 65 years).

Women are majorly affected especially after menopause accounting for almost 80% of hip fractures. Most of the older adults, who are healthy, will be able to live independently after treatment and rehabilitation. Some seniors fall and suffer from a fracture due to physical or mental disabilities, requiring long-term care and assistance.

Symptoms

Most commonly seen hip fractures in elders are the femoral neck and intertrochanteric regions, resulting from not only falls, but at times due to certain actions like rolling over in bed, getting up from a chair, or walking, all involving minimal force. The symptoms seen include:

  • Severe pain in the hip or groin
  • Immobility after the fall
  • Inability to bear weight on the injured leg
  • Shorter appearance of the injured leg, with foot and knee turned outwards
  • Stiffness, bruising or swelling in the hip

Treatment decisions are made based on an X-ray of the hip and femur.

Road to recovery

  • The main goal after the surgery is to regain mobility and activity in your daily life.
  • Walking aids such as a cane, walker or crutches might be needed initially.
  • By following the physical therapist’s instructions and taking the necessary precautions to prevent further falls, recovery will be faster.
  • Be mindful that healthy lifestyle choices will significantly reduce the risks of fracture recurrence.

In most cases surgery is the choice of hip fracture treatment, but in rare cases where the patient’s health condition and age is an added risk, then surgery would not be recommended. Such people will be put into traction (tension system) and confined to a bed. Hip fracture surgery involves:

Repairing with metal screws- If the bone is still aligned well, metal screws are inserted to hold it well till the fracture heals. This is done in intertrochanteric fractures. For additional stability, bone nails (gamma nails) are also used.
Replacement of part of the femur- In cases where the ends of the bone are broken, and alignment is lost, the head and neck of the femur is replaced with a metal prosthesis (artificial joint). This is known as hemiarthoplasty.
Total hip replacement- Here the upper femur and the socket of the pelvic bone is replaced with a metal prosthesis.Both, hemiarthoplasty and total hip replacement are surgical procedures used in older people. Nevertheless, the likelihood of total hip replacement depends upon the nature of fracture, severity of symptoms, personal risk associated and degree of mobility prior to the facture.

Post-surgical recovery

If all goes well, within one day post-surgery, the patient will be coaxed to move with the help of a walker.

Physical therapy will also be started, focusing on range of motion and strengthening exercises.

A week after the surgery and hospital stay, an extended care facility might be provided to the patient. After a month, working with an occupational therapist in extended care and at home, will teach the patient to perform day to day activities independently, such as using the toilet, bathing and dressing.

When total hip replacement has been done, advise on certain precautionary measures and to live effectively with the new hip is given to the recovering patient.

On returning home, prevention of accidents is important, by keeping the premises hazard free, and help from a nurse or family member will be required till recovery.

A hip fracture is a serious injury, and though treatable, at times some complications can occur, which may be life-threatening. When traction is applied instead of surgery, it can lead to following issues:

  • Muscle deterioration and weakness
  • Risk of permanent loss of mobility
  • Risk of developing blood clots (thrombosis)
  • Superficial or deep vein thrombosis

Rarely, when the patient does not get up and move around, a blood clot can get lodged in the pulmonary artery, and blood flow to the lungs gets blocked. This results in pulmonary embolism, which can be fatal.

Other complications as a result of immovability include bedsores, urinary tract infection and pneumonia.

There is also an increased risk of having another fracture in those who have suffered from one previously.

In those patients who have undergone total hip replacement, the average life expectancy of an artificial hip joint (prosthesis) is 10 to 15 years, after which hip revision surgery might be required, due to looseness of the joint or infection setting in.

The leading cause for fractures in elderly people is falls and most of these (more than 60%) happen at the home, while remaining happen in the community or institutions for the elderly. Hence, preventing these falls is very important, especially in the aged group, who tend to have fragile bones.

Multiple factors contribute to these falls; taking medication such as sedatives, conditions affecting balance (Parkinson’s disease), side effects of taking many medicines and alcohol consumption.

At home, certain arrangements might have to be made to make it a safer place:

  • Floors: All loose wires, rugs and any clutter must be removed.
  • Bathrooms: Bars should be placed for gripping and non-skid tape placed in the tub or shower
  • Lighting: Halls, stairways and entrances must be well-lit
  • Kitchen: Clean any spills immediately and keep non-skid mats near the sink.
  • Stairs: Make sure that railings are secure
  • Exercise: This improves balance, strength, coordination and flexibility

Supplementing daily diet with calcium (1,200 mg per day) and vitamin D (400 to 600 IU per day) is recommended. Sunlight exposure of 10 to 15 minutes twice a week will help ensure adequate levels of vitamin D.

Wearing proper footwear (rubber-soled) and avoiding risky behavior that can lead to falls is important.

Being unduly fearful about falling will not help; as such fear will prevent the person from being active and mobile.