A hip fracture, a break in the upper part of the thigh bone (femur) near the hip joint, is a serious injury, particularly for older adults. It can significantly affect their independence and overall well-being. Surgical intervention is almost always necessary to repair or replace the fractured hip, followed by physical therapy.
Understanding Hip Fractures in Older Adults
Hip fractures are more common in older adults, largely due to age-related physiological changes that weaken bones and increase the risk of falls. Osteoporosis, a condition characterized by decreased bone density, makes bones more fragile and prone to breaking. Even minor trauma, like a fall from a standing height, can result in a hip fracture. A fracture can also occur spontaneously from simply standing or twisting.
Hip fractures involve the upper part of the femur. These breaks can occur in the femoral neck, the narrow section just below the ball of the hip joint. They can also happen in the intertrochanteric area, located between the femoral neck and the long shaft of the thigh bone, or in the subtrochanteric area, below the lesser trochanter. The specific location and severity of the fracture guide the choice of surgical treatment.
Surgical Treatment Options
Treating hip fractures in older adults involves various surgical procedures, with the choice depending on the fracture’s location, severity, and the patient’s overall health. One common approach is internal fixation, where metal screws, pins, rods, or plates hold the broken bone fragments together while they heal. Undisplaced femoral neck fractures may be treated with parallel screws or a sliding hip screw.
Partial hip replacement, also known as hemiarthroplasty, replaces only the damaged ball-like head of the thigh bone with a prosthetic implant. This procedure is recommended for displaced femoral neck fractures, especially if the blood supply to the femoral head was compromised. Total hip replacement involves replacing both the femoral head and the natural socket in the pelvic bone with artificial parts. This replacement is considered for active older adults, as it can offer better long-term outcomes.
The Surgical Process and Immediate Aftercare
Prior to surgery, patients undergo preoperative optimization, which may include managing existing medical conditions and providing nutritional support. The surgical procedure involves either general anesthesia or regional anesthesia, such as spinal or epidural anesthesia. Regional anesthesia is favored for benefits including reduced risk of blood clots, improved pain management, and fewer respiratory complications.
The aim is to perform hip fracture surgery within 48 hours of admission to minimize hospital stay and complications. Following surgery, immediate aftercare focuses on pain management, using a combination of medications and regional nerve blocks. Early mobilization is a primary goal, with patients encouraged to get out of bed and begin walking with assistance within hours or the first day after surgery. This early movement helps prevent complications such as blood clots, pneumonia, and bedsores. Monitoring for immediate complications like bleeding or infection is also continuous.
Rehabilitation and Long-Term Recovery
The recovery journey after hip fracture surgery for older adults is a structured process emphasizing regaining mobility and independence. Physical therapy begins soon after surgery, focusing on goal-directed mobilization, balance exercises, and functional training. Occupational therapy also helps patients relearn daily activities and adapt to new ways of performing tasks.
Pain management continues post-discharge, with prescribed medications and encouragement of movement to alleviate discomfort. The transition from hospital involves moving to a rehabilitation facility for intensive inpatient therapy or receiving home care, including visits from physical and occupational therapists. Potential complications during recovery include infections, blood clots, and non-union of the bone. Full recovery can take several months, with regaining pre-fracture mobility and independence being a key goal.
Key Considerations for Older Patients
Managing hip fractures in older adults extends beyond surgical repair and recovery, encompassing several unique considerations. Pre-existing medical conditions, or comorbidities, can significantly influence both the surgical procedure and the post-operative recovery process. Conditions like heart disease, diabetes, or respiratory issues can increase the risk of complications.
Post-operative delirium, a temporary state of confusion and disorientation, is another concern that can occur after surgery. This condition is associated with longer hospital stays and can impact functional recovery. Nutritional support, including adequate intake of protein, calcium, and vitamin D, is also important for bone healing and overall recovery. A multidisciplinary care team, involving orthopedic surgeons, geriatricians, nurses, physical therapists, occupational therapists, and social workers, is beneficial in optimizing outcomes.