Download Your broken hip explained

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
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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.
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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..
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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.
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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:
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•
•
•
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.
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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.
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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:
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•
•
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.