A hip fracture is a break in the upper quarter of the femur, or thigh bone, near the hip joint. This injury causes extreme pain and significant muscle spasm, often leading to the injured leg appearing shorter or externally rotated. Incorrect movement before stabilization risks displacing fractured bone fragments, potentially damaging surrounding tissues, nerves, or blood vessels. The immediate priority is to minimize all patient movement and contact emergency medical services for professional transport.
Immediate Stabilization and Immobilization
While waiting for medical professionals, the primary goal is to stabilize the limb in a position of comfort or natural alignment to reduce pain and prevent secondary injury. Attempting to forcefully realign or “set” the bone is dangerous and must be avoided by untrained individuals. The injured leg should be visually assessed for deformity, and circulation should be checked by noting the color and temperature of the foot.
The most effective way to manage the fractured hip is to cradle it gently with padding, using materials like soft blankets or pillows placed underneath the entire length of the leg. This padding helps fill the space between the patient’s body and the floor or bed, offering passive support to the limb. Once cradled, the injured leg should be secured to the uninjured leg using broad strips of cloth or ties, effectively turning the healthy limb into a makeshift splint. This binding prevents painful rotation or adduction of the broken hip.
Securing the legs together, with padding between the knees and ankles, minimizes movement at the fracture site and helps control intense muscle spasms. It is also important to maintain the patient’s normal body temperature by covering them with a light blanket, as shock and immobility can lead to cooling. Caregivers must restrict the patient from consuming any food or drink, as an empty stomach is necessary for anesthesia if surgery is required.
Safe Patient Transfer and Movement Techniques
Moving a patient with a hip fracture is a high-risk procedure requiring coordination and a minimum of three trained individuals. When moving the patient to a transport device, the entire body must be moved as a single unit to prevent twisting or bending at the hip or spine. This process requires a coordinated command to ensure all team members lift or slide simultaneously.
Procedural movement often involves using a slide board or a draw sheet, which is a strong sheet placed beneath the patient’s body from the shoulders to the hips. Once the patient is gently rolled onto the sheet, the team uses the edges to lift and slide the patient laterally onto the stretcher or bed. This technique maintains the body’s longitudinal alignment and minimizes shear forces across the fracture site.
During the coordinated lift, one person should maintain gentle, continuous traction on the injured limb, pulling slightly along the limb’s long axis. This gentle pull counteracts muscle contraction and helps reduce the grinding of bone fragments during the transfer. The movement must be slow and deliberate, with constant monitoring of the patient’s pain level to ensure no sudden, jarring motions occur.
Positioning for Post-Surgical Recovery
Post-surgical positioning is dictated by the specific operative approach used by the orthopedic surgeon, most commonly the anterior (front) or posterior (back) approach. These precautions prevent hip dislocation, a complication where the new ball and socket joint separates. The posterior approach, which involves cutting through muscles and external rotators at the back of the hip, requires the strictest precautions.
Patients who have undergone a posterior approach must avoid three specific movements for several weeks: hip flexion past 90 degrees, adduction (crossing the legs past the midline), and internal rotation (turning the toes inward). These movements put the hip joint in its most vulnerable position for dislocation. To comply, the patient must use an elevated toilet seat and avoid sitting in low chairs, which force the hip joint beyond the 90-degree flexion limit.
When resting in bed after a posterior approach, an abduction pillow or wedge must be placed between the legs to prevent crossing or adduction during sleep. When turning the patient, they should generally be turned only onto the uninjured side initially. The pillow must remain securely between the thighs to keep the surgical hip in a stable, neutral position.
The anterior approach is a muscle-sparing technique, often requiring fewer or no formal positioning precautions, leading to a faster return to mobility. If precautions are mandated, they typically involve avoiding hip hyperextension (moving the leg backward) and excessive external rotation. Regardless of the surgical method, patients must follow the specific instructions and duration provided by their surgeon and physical therapist for the safest recovery.