A broken hip is a fracture in the upper part of the femur, or thigh bone, near the hip joint. This injury significantly affects mobility, especially for older adults. Healing is complex and varies among individuals, influenced by many factors.
Factors Influencing Healing Time
The type of fracture plays a significant role. Femoral neck fractures, located just below the hip ball, are intracapsular and can disrupt blood supply, potentially leading to slower healing or avascular necrosis. Intertrochanteric fractures, between the femoral neck and shaft, generally have better blood supply. Subtrochanteric fractures, below the trochanters, often result from high-energy trauma and can be more challenging.
Age and overall health also influence recovery. Younger, healthier individuals heal faster than older adults, whose bones may be brittle due to osteoporosis. Pre-existing conditions like diabetes, poor circulation, or nutritional deficiencies can impede bone healing. Lifestyle choices, including smoking and excessive alcohol, also delay healing, with smoking linked to non-union and surgical site infections.
Most hip fractures require surgery. Options include internal fixation (screws, pins, plates) or partial/total hip replacement, common for older adults. Other injuries or comorbidities can prolong recovery.
Phases of Recovery
Recovery from a broken hip progresses through distinct phases. The acute phase immediately follows injury and surgery, lasting days to weeks. Pain management is a primary focus, often with systemic analgesia and nerve blocks. Early mobilization begins within 24 hours post-surgery to prevent blood clots and muscle atrophy. Wound care is also important to prevent infection.
The sub-acute phase, from three to twelve weeks, begins formal physical therapy. This stage emphasizes regaining strength, increasing range of motion, and gradually introducing weight-bearing activities. Physical therapists guide patients through exercises to strengthen muscles, improve balance, and enhance coordination. Patients may use assistive devices like walkers or crutches.
Long-term recovery extends from several months to over a year, focusing on functional integration and bone consolidation. Bone continues to heal and strengthen, often confirmed by X-rays around six months. Rehabilitation intensifies, aiming to restore pre-injury mobility and activity levels. This phase involves advanced balance training, endurance exercises, and a gradual return to daily routines, though high-impact activities may be restricted. Consistent effort is important for long-term outcomes.
Managing Recovery and Rehabilitation
Managing recovery involves a comprehensive approach to restoring function and independence. Pain management is an immediate priority after surgery. Healthcare providers use medications like paracetamol, NSAIDs, and opioids. Nerve blocks provide targeted relief and facilitate early mobilization.
Physical therapy (PT) and occupational therapy (OT) are integral to rehabilitation, often beginning within 24 hours of surgery. PT focuses on improving strength, mobility, and balance through progressive exercises. OT helps patients relearn daily living skills like dressing and bathing, adapting techniques and recommending assistive devices.
Assistive devices like walkers, crutches, or canes support mobility and reduce weight-bearing. Modifying the home environment prevents falls, including removing tripping hazards and installing grab bars. Regular follow-up appointments with healthcare providers monitor healing, manage complications, and adjust the rehabilitation plan.
Potential Complications Affecting Healing
Several potential complications can arise during healing, potentially prolonging recovery or necessitating further intervention. Infection, particularly at the surgical site, can impede healing. Symptoms like fever, increased pain, or drainage warrant immediate medical attention.
Non-union or malunion occur when the bone fails to heal properly. Non-union means fractured parts do not join, causing persistent pain and instability. Malunion is healing in incorrect alignment, potentially causing deformity or impairment. Both can result from inadequate blood supply or insufficient stability.
Avascular necrosis, common with femoral neck fractures, occurs when blood supply to the bone is disrupted, leading to tissue death and potential additional surgery. Deep vein thrombosis (DVT) and pulmonary embolism (PE) are risks due to immobility; preventive measures include compression stockings and blood thinners. Pressure ulcers can also develop from prolonged immobility.