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Adapted from Royal Bath Hospital Your broken hip explained A patient’s guide Whittington Health Magdala Avenue London N19 5NF Phone: 020 7272 3070 Date published: 19/03/2012 Review date: 19/03/2014 Ref: Ortho/BHE/1 ©Whittington Health Please recycle …. caring for you Page one What is a broken hip or hip fracture? The hip joint is ball and socket joint between the femur (thigh bone) and pelvis. A fracture of the femur in this area may be called a hip fracture or broken hip. Sometimes the bone ends stay completely against each other after a fracture but more often they move apart. Leaflets. There are a range of leaflets pertaining to information you might require. For more information or a patient leaflet, please refer to www.whittington.nhs.uk our services, patient leaflets. Volunteers. You may see volunteers on your ward they are there to provide assistance to you. They may offer you companionship or run errands for you. Some volunteers bring a mobile library trolley to the wards. If you would like to know how the volunteers can assist you or how you can become a volunteer, please call 020 7288 3282. Interpreting services . If you require an interpreter please ask a member of staff to contact the interpreting services on 020 7288 5191 /5114/ 3974 /3226. How will the doctors fix my hip? Almost all hip fractures require an operation before it is possible to walk again. The fracture can occur in two different areas of the femur, the types of fracture are treated as follows. Hemiarthroplasty (half joint replacement) A fracture of the neck of femur bone can damage blood supply to the head of the femur (hip joint). If this blood supply is damaged the bone will not heal. This operation involves removing the head and neck section of the bone above the fracture and replacing it with a metal ball and stem which fits into the top end of the thigh bone. Page nine You will be given information leaflets about these medications from the pharmacists and your doctor will need to prescribe them for you after your discharge from hospital. When osteoporosis is less likely, an osteoporosis scan (DEXA scan) will be organised. The results of the DEXA scan will be sent to your GP and you will need to contact your doctor’s surgery for the results and advice on treatment.. Page two Dynamic hip screw If the fracture has occurred further down the femur (beyond the neck), we perform a dynamic hip screw operation, to the side of the thigh bone at the top and a long screw across the fracture into the head section. This holds the ends of the bone together while they heal. Will I need an outpatient appointment? Few patients with hip fracture need to be seen in outpatients. Those that do need to be seen will have an appointment made for them prior to discharge. On discharge home you will be referred to a district nurse to administer your blood thinning injection that you will have been receiving in hospital. Whilst on the ward the nurses will see if you would like to carry this out yourself, don’t worry if your not able the nurse will then come into your home up until day 28 following your operation. You will be given an information leaflet about this also. Cannulated screw In some femoral neck fractures, the bones may not move apart and the blood supply may not be damaged. The surgeon may recommend that three screws are used to hold the ends of the bone together while they heal. Page three Page eight Intramedullary nail There are occasions when the fracture is lower in the femur then the surgeon will use an intramedullary nail to allow healing to take place. To assist this you may need adaptations to your furniture height or equipment for reaching. Whilst in the ward you will be assessed by a consultant orthopaedic geriatrician, this is a care of older people consultant who advises the orthopaedic consultants on your medical care. Preventing further falls It is important to find out why you fell as some causes of falls, such as poor balance or variable blood pressure, or heart rhythm problems might be prevented in future. While you are in hospital you will be seen by the care of the elderly doctors and the therapists who will ask about your fall and whether you have had other recent falls. In each case the metalwork will stay in the hip forever. Before you agree to have the operation your surgeon will explain your fracture type and the operation they recommend. They will also explain the risks of surgery to you. The surgeon can also speak to your close family if you wish. What will happen to me before my operation? On arrival in the emergency department following your fall or accident you will have x-rays, blood tests and a tracing of your heart electrocardiogram, (ECG). This ensures that you are safely prepared for the anaesthetic that you will require. Also the following will happen prior to your surgery, most of it in the ward area: • • • • you will also be given painkillers and a needle inserted into your arm to allow staff to give you some intravenous fluids to maintain hydration the doctor will mark your broken hip with an arrow you will have tight stockings or calf pumps applied to reduce the chance of blood clots forming in your legs the nurse may insert a catheter (tube into your bladder) if it will be difficult for you to use a bed pan and it is felt that it is necessary. They will also ask about problems with your memory, eyesight and hearing. The doctors will examine you and review your medication. If necessary they will arrange further investigations and an appointment in the fall clinic in the Dorothy Warren day hospital. Preventing further fractures (broken bones) Osteoporosis (brittle bones) is an important issue and is common in patients with hip fracture especially in women older than 76 years. However, it is also present in some younger women and men. The medical team will usually check whether you have osteoporosis while you are in the ward. You can find more information about this condition in the leaflets displayed in the patient information area. In most cases the doctors will recommend regular calcium and vitamin D tablets along with a specific osteoporosis tablet such as weekly alendronate. It is important that the alendronate is taken as recommended with water, on an empty stomach and sitting upright with no food for 30 minutes. If you do not follow these instructions the medication will not work and will cause side-effects. If you can’t tolerate this medication you will be given strontium (a drink) in the evenings or alternatively may be given an infusion of a drug to protect your bones for the future. Page seven Page four The occupational therapist will need to know from your family the heights of your furniture at home. They will give you a form asking for this information. If your furniture is at the correct height there is less chance of you over-bending your hip in the first weeks after your operation. If the heights are not correct then the occupational therapist can arrange for adaptive equipment to be fitted before you go home. as soon as you are able to get in and out of bed with help, we will remove your catheter. This is to reduce the risk of urine infection. You may experience a little difficulty controlling urine for the first day after removal of the catheter. If this persists please tell your nurse. Other patients may need a longer period of rehabilitation in hospital. In this case we will recommend that you transfer to a local rehabilitation unit in the borough that you live in. This will be discussed with you and your family. How long will I be in hospital? Some patients recover very quickly from their operation, our aim now is to enable patient to be discharged within seven days of their operation. This will not always be feasible for each person; all cases will be treated individually. The team of nurses and therapists will assess your progress daily. They will advise you and your family at an early stage how long you are likely to be in hospital and the rehabilitation you will need. How can I protect my hip after a hemiarthroplasty operation? Hip fractures fixed with a joint replacement (hemiarthroplasty) are at increased risk of dislocation. To reduce the risk we recommend the following three precautions:-Avoid crossing your legs. In bed, where possible, try to sleep on your back or at least place a pillow between your knees when in bed. Avoid bending to more than 90 degrees at your hips, e.g. reaching below your knees. Before the operation the anaesthetist will also come and speak to you about your general health and ask questions about any previous anaesthetics you may have had. We aim to operate within 24 hours but sometimes due to medical conditions that you may have this is not always possible. Also operations are sometimes delayed if there is an increased demand for emergency surgery. On the ward the nursing staff will ask you some questions about yourself, address etc, so that we have correct details about you and also your next of kin details. They will also carry out some assessments on you in regards moving and handling, your nutritional intake. This is to ensure that you are cared for holistically. To facilitate your return back home, you will be referred to the social work department with your permission. This is done on day of arrival so as to enable a smooth, quick and effective discharge. The social worker can discuss with you and your family what is available depending on the borough that you live in. In some cases there is a small fee to be paid by you. What will happen to me after my operation? Following your surgery, you will be taken to the recovery room to monitor you and manage your pain effectively prior to returning to the trauma ward. You may feel a little sick and groggy following the operation and the nurses will give you an anti sickness injection. Some patients require a blood transfusion after the operation if they have become very anaemic (low blood count) during the surgery. There is a leaflet available for you to read. Page five Page six On the afternoon/evening of your surgery the nurses/therapists will assist you if able to sit on the edge of the bed. The following morning the physiotherapist and occupational therapist will get you up and start you walking again with frame/crutches. They will also ask you questions about your home environment so that they can start planning your discharge back to a safe environment. Your leg should start to feel more comfortable now. Pain is normal and to be expected but we will try to control it with painkillers. This means you may not be pain free when mobilising so please let the staff know and they can assist you. Constipation is very common following a hip operation due to: • • • limited mobility reduced dietary intake strong painkillers You will be prescribed laxatives on admission to the ward. Will my hip be as good as new after the operation? A hip fracture is often a life changing event. Although some patients may return to their previous ability, some do not. This may be due to damage caused to the bone, muscle and ligaments as a result of the fracture or because you cannot do all the exercise we recommend. Hip fracture often occurs in people who have several medical conditions or who are otherwise frail. The effect of these conditions or frailty can affect your overall recovery. What exercises will I do? The physiotherapists and nurses will help you start to regain your confidence and ability with walking by helping you practice on the ward. We encourage patients to walk out to the bathroom whenever possible (with someone) to increase your mobility and also to promote your independence. The physiotherapists will give you another other specific exercises that you may need to do. What help will I have with rehabilitation? Getting back to normal life is a very personal experience. Some people need more time than others. You are the key person in promoting your return to your usual ability. You may find it helpful to set small goals, gradually increasing the amount you do each day. Within the ward the physiotherapists, nurses and occupational therapists. Occupational therapists are involved with helping you cope with everyday tasks such as dressing and cooking and will support your progress. We will encourage you to start practicing putting on your day clothes as soon as you are able to sit out again. Please ensure that your relatives and friends bring in some loose fitting day clothes. However, we do not have a laundry service on the ward, so they would need to take them home for laundry purposes. Flat well fitting slippers are better than loose fitting slippers, so please ask your family to bring these. You will also need nightwear, toiletries, toothbrush and toothpaste. Occupational therapist (OT) Will also discuss with you about equipment that you may require at home. They may also need access to your property which they will discuss with you and your family. This is to enable them to make sure your home environment is safe for you to return to, i.e. loose rugs will need to be removed.