Hip Fracture Orthopaedic Department Patient Information Leaflet
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1 riginator: Anne Flavall Professional Development Lead, Mr Marsh and Mr Quraishi Orthopaedic Consultant Surgeons Date: March 2012 Version: 2 Date for Review: March 2015 DGOH Ref No: DGOH/PIL/00611 Hip Fracture Orthopaedic Department U nd er re vi e w Patient Information Leaflet
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3 Useful contact numbers If you have any concerns / problems please speak to a member of staff or contact the ward on extension Hip Fracture Welcome to The Dudley Group of Hospitals. This leaflet will provide you and your relatives with information about your hip fracture and how it will be treated. Introduction A hip fracture is a common injury that usually affects people over the age of 65. As the skeleton ages, your bones slowly lose minerals and become less dense and weaker due to osteoporosis. This can make them prone to breaking, especially during a fall. There is a separate leaflet on osteoporosis available, please ask a member of staff for a copy of this leaflet. Falls can happen for a number of reasons. It may be a simple trip; however, there may be a medical reason (such as low blood pressure) which caused your fall. If you fracture your hip, the doctors will usually look for the reason you have fallen and may also want to treat you for any underlying reasons relating to your fall. A hip fracture can also occur in younger people. In these cases, it is more likely to be caused by accidents such as road traffic accidents or a fall from a significant height. What is a hip fracture? A hip fracture is often referred to as a fractured neck of femur. The hip joint is a ball and socket joint where the top of your thigh bone (femur) meets your pelvis. Your hip can break in different places and this can determine the treatment you will be given. 10 3
4 What is the treatment for a hip fracture? Most people who have a hip fracture need surgery to treat the fracture. The type of surgery that you have will depend on which part of your hip is fractured. You can discuss the options available with the orthopaedic surgeon who will be performing your operation. Intra-capsular hip fracture In this type of injury, the ball on top of the thigh bone has broken off at its junction with the narrow neck of the thigh bone. The blood supply to the ball can be seriously injured. To treat this you will often need a procedure called a hemiarthroplasty. This is where the head of the thigh bone is replaced with half a hip replacement. Extra-capsular hip fracture In this type of injury, the thigh bone is broken at the junction between the neck and the shaft of the thigh bone. To treat this, the surgery you will need involves putting the fracture back together and repairing it with plates and screws. What happens next? Following surgery, most patients are cared for on the hip fracture suite. This allows a specialist team to provide care and plan for your discharge from hospital. A date of discharge will be discussed with you. It is hoped that you will be fit enough to go home or transferred to the rehabilitation ward 5-7 days following surgery. A team of healthcare professionals (which include orthopaedic surgeons, ortho-geriatrian medical lead, ward nurses physiotherapists and occupational therapists) will be responsible for your rehabilitation. This team will aid you to reach your maximum level of function and independence and to help with any adjustments you may need in your home setting. A care plan will be made to suit your individual needs (this is called an integrated care pathway) and is designed to focus on getting you home as swiftly as possible. The discharge team will be responsible for liaising and setting up any home services you may require. Your previous level of independence will influence your post operative rehabilitation. Often you will not regain the same level of mobility that you experienced before your injury and rehabilitation will continue following your discharge from hospital. All aspects of your care will be discussed with you and your relatives as required. We encourage you to ask us any questions you may have with regard to any aspects of care or treatment. 4 9
5 Deep vein thrombosis (DVT) this is a blood clot in leg veins and can be caused by immobility. As you will be less mobile after a hip fracture you will usually be given a small daily injection into your abdomen to thin the blood and will normally be asked to wear elasticated stockings which help the blood flow in your legs. Ankle exercises will also help reduce the blood pooling in your legs. All these measures reduce the risk of DVT. Following surgery, it is important that you mobilize and are encouraged to walk. For further information, please refer to the leaflet on DVT. Ask a member of staff for a copy of this leaflet. Pulmonary embolism occasionally clots from the legs, or fat from the broken bone, can break off and travel to the lungs in the circulation. Rarely, these can be fatal. Blood loss you may require fluid or a blood transfusion via a drip to replace blood loss either from the fracture itself or during surgery. It is important that you drink plenty of fluids. Pressure ulcers if you are not very mobile and are spending long periods in bed or in a chair, you are at increased risk of developing pressure ulcers. All patients are nursed on a pressure relieving mattress and encouraged to change their position on a regular basis. The purpose of surgery The main purpose of having surgery is to allow earlier mobilisation with a goal of allowing you to regain as much independence as possible, as quickly as possible and reduce the risk of complications associated with non-surgical treatment. Surgery is the most common treatment and usually gives the best outcome for a hip fracture. Alternatives Some hip fractures can be left to heal by themselves but this would usually mean prolonged bed rest. With this treatment there is no guarantee that the bones will heal properly, allowing normal walking. There is a high risk of serious illness with this method including: blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism), pneumonia, urine infection and skin damage (pressure sores) resulting from lying in bed. Preparation for surgery You will not be able to eat or drink from midnight the day before your surgery. An anaesthetist will assess you and decide if you are fit for surgery. The type of anaesthetic you will have will be dependent on your general health. 8 5
6 Aftercare advice following surgery There is a possibility that you may become slightly disorientated. Normally this is nothing to be concerned about and will correct itself in a few days. We estimate that you will need to stay in hospital for 5-7 days. We encourage your relatives and friends to be involved in your rehabilitation including encouraging you to get dressed during the day. It is important to: Ensure that you have a high fibre diet and plenty of fluids. Pain relievers and reduced mobility sometimes cause constipation; laxatives can be given if required. Take regular pain relief. If you are in any pain it is important to tell the nurse. Change position in bed to prevent pressure ulcers. Do deep breathing exercises and keep mobile to help prevent chest infections. Start mobilising as soon as possible. This helps with healing and prevents complications. You will start walking on the first day following surgery and be seen by the physiotherapist to be shown how to walk with a zimmer frame. You will hopefully progress to crutches as your confidence and mobility increases. Do ankle exercises which will help prevent deep vein thrombosis. Have well fitting slippers and clothing brought in to allow you to walk around the ward. Are there any side effects or complications after a hip fracture? As with any operation there is always a risk of complications. A broken hip is a serious injury and this, combined with medical problems associated with age, can increase the risk of complications occurring. It is necessary to ensure that you are as fit as possible before your operation and this can sometimes delay surgery. On rare occasions surgery can be classed as very high risk and is not recommended. Complications may include: Infection you will be given antibiotics in the operating theatre to reduce the risk of infection. To help prevent wound infection, it is important not to touch the wound site. In general the wound is covered in a sterile dressing until the clips or stitches are removed and healed. Chest infection may develop following surgery and is treated with antibiotics, deep breathing exercises and chest physiotherapy. Poor physical health can increase the risks of infection. It is essential that you have a healthy diet, and drink plenty of fluids to aid bone healing. If you are not eating a balanced diet supplements can be prescribed. 6 7
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