Dealing with a Fractured Hip

April 9th, 2008

A hip fracture, one of the most dreaded injuries, can be devastating and complicated. This medical emergency is a painful, stressful and life-changing event. One in five persons over age 50 who breaks a hip will die within a year. Forty percent of hip-fracture patients over age 65 move to a nursing home after hospitalization.

The risk of a hip fracture rises with age. Those with brittle bones (osteopenia or osteoporosis) are most likely to suffer a hip fracture from falling, or in some cases, just the stress of walking can cause the femur to snap. Protective reflexes in older adults are slower and make it more difficult to avoid falling directly on a hip. In addition, certain medications, such as SSRIs and oral corticosteroids, may increase fracture risk.

A few people are “fortunate” enough to have stable fractures so that they are able to avoid surgery and move around after a few days of rest. The majority of hip fracture patients undergo surgery within 24 hours of being admitted to the hospital. Hip fractures can sometimes heal without surgery after up to three months of bed rest. However, prolonged immobility can lead to complications such as pressure sores, deep vain thrombosis (DVT), and muscle loss. The risk of DVT can be reduced with pressure stockings and blood-thinners, but the best protection involves getting up and moving around as soon as possible after surgery. Any unusual heat, pain and swelling in the leg can indicate that DVT has developed, during which a clot can travel to the lung or brain.

Recovering the ability to walk is unlikely following several months of bed rest. Because urinary catheters must be used when the patient is confined to bed, urinary tract infections are an additional risk. Catheters should be removed as soon as possible. If the patient is immobilized for long periods, pneumonia may set in. Delirium can be another complication to watch for, including delusions, agitation and hallucinations. Less subtle symptoms and more commonly seen are impaired ability to focus, disorientation, and memory and language problems. These symptoms may be overlooked due to heavy sedation for pain and in those suffering from dementia.

The prognosis for recovery is best in cases where hip surgery is an option. The type of hip surgery is determined by the location of the fracture. Surgery is the beginning of the long road to recovery. Only the patient can do the painful and difficult work of rehabilitation, which starts as soon as possible after the operation. Physical therapists help the patient to walk to a chair and use the bathroom. Therapy progresses to include exercises to strengthen muscles and learning to use a walker and a cane.

The patient may go to a rehab center for two weeks, followed by several months of outpatient therapy. Not everyone is able to return home after rehabilitation is completed. Some go to a nursing home and continue their physical therapy before they are able to return home. Others may need to stay there permanently to receive the support the need.

Living at home after a hip fracture can be complicated and difficult for all concerned. Pain and setbacks can impede the recovery process. The home environment should be modified in order to make it easier for the patient to function and remain active while minimizing pain. Soreness can persist for a month or longer, and the individual can quickly lose strength if not strongly motivated to continue exercises learned in rehab. Depression can also sap the desire to continue rehabilitation.

Caregivers should understand that the hip fracture patient has a high risk of a second fracture. In many cases where thin bones are involved, the physician will prescribe life-long osteoporosis therapy to strengthen bones and reduce risks of future falls and fractures. It is vital that the patient also gets adequate calcium intake – 1,200 to 1,500 mg daily for people over 50 and vitamin D of 800 IU daily. Calcium and vitamin D strengthen bones and lower the risk of falling again.

Seniors can do a great deal to avoid the pitfalls of a hip fracture. For those with thinning bones, osteoporosis therapy and Calcium can help as preventive measures. Getting adequate exercise, using hand-held weights to build bone, and working on balance are also useful. Those who are unsteady on their feet should have a walking companion and use a cane. Obstacles such as loose throw rugs should be removed from the home. When exercising outdoors, walking on an even surface can help to prevent tripping and falling.

Johns Hopkins Medical Letter: Health After 50; August 2007

Entry Filed under: MEDICAL DISCOVERIES