Following a hip fracture
Information for patients and their carers
This booklet is designed to answer some of your questions about your hip fracture and your hip operation including the benefits, risks and any alternatives and what you can expect when you come to hospital.
It also explains more about returning to your everyday activities after your hip operation and how to prevent any more falls or injuries.
If you have any further questions, please speak to a doctor or nurse caring for you.
While in hospital you will be looked after by a team who will work together to care for you and treat your hip fracture in the best way (based on national guidelines).
Your team will usually include:
· an orthopaedic surgeon:______
· an orthogeriatrician:______
· medical team
· nursing staff
· an occupational therapist:______
· a physiotherapist:______
What is a hip fracture?
The hip is a ball and socket joint. The ball is the rounded top part of the thigh bone (femur). The socket is the cup shaped part of the pelvic bone that the ball of the femur sits inside. A hip fracture is a crack or break in the top end (neck) of the femur. This is known as a neck of femur or NOF fracture.
What treatments are available?
There are several different ways your hip fracture can be treated. You will normally need an operation but sometimes the fracture may be left to heal naturally. The orthopaedic surgeon will think about your age and fitness, how you broke your hip and the health of your bones when choosing how to fix your hip.
Different ways of fixing your hip include:
Intramedullary nail
· A metal rod is inserted in to the bone to stabilise the fracture
· A second stabilising screw is fixed in to the neck of femur
Hemiarthroplasty
· Replacement of one half of the hip joint
· The ball of the joint (femur) is replaced and the socket (acetabulum) remains
Dynamic hip screw
· A screw, plate and smaller screws are inserted into the neck of femur
· This allows movement of the head of femur
Total hip replacement
· Removal of the ball and socket parts of the hip joint
· Two prosthetic implants are inserted that attach to each other to replace the ball and socket, or whole hip joint
Cannulated screws
· Metal screws are inserted into the neck of femur to stabilise the fracture
Your hip has been fixed with: ______
Asking for your consent
It is important that you feel involved in decisions about your care. For some treatments, you will be asked to sign a consent form to say that you agree to have the treatment and understand what it involves. You can withdraw your consent at any time, even if you have said ‘yes’ previously. If you would like more details about our consent process, please ask a nurse/doctor in charge of your care.
What are the benefits of having a hip fracture operation?
The aim of the operation is to stabilise the fracture to allow it to heal and to provide long term pain relief. This should mean that you can get back your normal movement and carry on with your daily activities.
What are the risks of having a hip fracture operation?
There are always risks with any operation. Some of these risks include pain, bleeding, infection, clots in the legs or lungs and limb swelling, which can mean a loss of feeling in your leg or a loss of movement of the leg. There is also a risk that the bone does not heal.
Are there any alternatives to a hip fracture operation?
It is possible to think about other ways of helping your hip fracture to heal (non-operative management) but this can come with risks – you will need to discuss this with your consultant.
What should I expect before my operation?
An orthopaedic doctor will assess you either in the emergency department or on the ward. The type of surgery you need will be explained to you and you or your next of kin will be asked to sign a consent form.
When you are admitted to the ward your nurse will introduce themselves and answer any questions you may have. They will give you a pressure ulcer prevention leaflet and advise you when to stop eating and drinking (this is called being nil-by-mouth or NBM) before your operation.
If you have any medical conditions e.g. diabetes or a heart or chest condition you may need to be seen by a specialist physician. One of the anaesthetists will also see you and may request some extra tests before your operation.
You may be asked to stop taking some medications before your operation which a doctor or pharmacist will discuss with you. Your doctor or pharmacist will also let you know when these medications can be restarted after your operation.
How should I expect to feel after my operation?
You will be kept in the recovery room until you are well enough to return to the ward. The nurses will monitor you and record your heart rate, blood pressure and oxygen levels regularly. You will have a dressing over your surgical wound site which the nurses will look after (this may be sore).
You might be lying on a special mattress to help promote healthy skin.
Your hip may be painful, swollen and bruised. It is important to let your nurse know if you are in pain as they may be able to give you additional medication to help with this. The general anaesthetic might make you feel tired or dizzy for a day or two, but this should not prevent you from getting up.
What should I expect to be doing after my operation?
Following your operation the aim is to get moving again as soon as possible. Your therapist will advise you how much weight you can put on your operated leg and will explain any other instructions from your surgeon.
Day one
The nurses will monitor you and record your pain and vital signs every four hours.
You will be encouraged to resume eating and drinking as normal.
You will be assisted to wash, dress, get out of bed and begin walking.
Your orthopaedic team and the therapy staff will check you on the ward.
Day two
By the second day, your hip pain may start to settle and you should be able to move more.
You will be encouraged to get washed and dressed into your own clothes by yourself. Once your bowels are working normally the nurses will remove your urinary catheter and you will be able to use the toilet or commode.
You will sit out of bed in a chair again and start moving around the ward using a walking aid.
Day three through to discharge
You will be able to sit in a chair for all meals and increase the distance you walk with less and less help from nurses or therapists.
The nursing staff will keep monitoring your wound - the clips or stitches will normally need to be taken out after 10-14 days. If you have been discharged from hospital at this point, a referral will be made for a nurse to do this in your GP surgery or at home.
The team will start helping you to plan your discharge from hospital as soon as possible. Your physiotherapist and occupational therapist will work with you to help you try to get back to your old level of ability. Your length of stay at the hospital will normally be 7-10 days.
On-going rehabilitation may be needed to help you reach your goals. You can have this as an outpatient in your local hospital, at your home or at a residential rehabilitation facility - your therapists will talk you through the options.
Physiotherapy
On the first day after your operation you can start to do the exercises in this booklet. Each day you should practice your exercises and do them in between walking practice.
Doing these exercises will help you get stronger, move more and carry out tasks more easily. By doing them regularly you should be able to build up the amount of exercise you can cope with (your exercise tolerance).
Exercises
Ankle pumps
· Move your feet briskly up and down.
· Repeat 10 to15 times, every hour.
Bottom squeezes (static glutes)
· Tighten your bottom muscles by squeezing together.
· Repeat 10 to 15 times, every hour.
Thigh squeezes (static quads)
· Tighten your thigh muscles by pushing the back of your knee into the bed (straightening your knee as much as possible).
· Hold for a count of five, and then relax.
· Repeat 10 times every hour.
Knee flexion
· Slide your heel towards your bottom, so your hip and knee bend. Then straighten your leg.
· Your physiotherapist may help you move your injured leg at first.
· Repeat 10 times, three times a day.
Hip abduction
• Slide your leg out to the side, keeping your knee straight. Then return your leg back to the middle.
• Your physiotherapist may help you move the injured leg at first, until you can manage the exercise on your own.
• Repeat 10 times, three times a day.
Leg lifts (inner range quads)
· Place a rolled towel under the knee of your operated leg.
· Tighten your thigh muscles and straighten the knee lifting your heel off the bed.
· Hold your leg straight for a count of five seconds, and then lower it gently.
· Repeat 10 times, three times a day.
Standing practise
· With help to start with, cross your arms, while keeping your feet hip-width apart.
· Shuffle your bottom to the edge of the chair and stand up.
· Repeat 10 times.
Standing hip abduction
· Stand with the support of a chair on one side.
· Take your weight through your good leg and move your operated leg out to the side.
· Repeat 10 times.
Hip marching
· This exercise will be done with your therapist.
· While standing, lift alternate legs to march on the spot.
· You may use a walking aid to help you balance.
Occupational therapy
Your occupational therapist (OT) will complete a thorough assessment and work with you to improve your everyday living skills after your operation. This will include setting your own goals (self-care, leisure or work related) to help you move safely from hospital to life back at home and to help you get back as much independence as you can.
Your OT will talk with you and your family about your day-to-day life and how you will manage at home. This might cover:
· home environment
· daily activities
· whether you have steps or stairs
· how suitable your furniture at home is (e.g. seating)
· whether someone can help with household jobs and shopping.
Your OT will work with you to make sure you can return to your usual activities after your operation. This may involve looking at how you will manage:
· washing
· dressing
· making a drink or a meal.
Your OT may ask that a relative or friend take some measurements and/or photographs of your home or they may carry out a visit to your home themselves to see if any equipment or changes could help you. Depending on your needs, your OT will be able to give you advice and practical help about:
· adaptive aids
· new ways of doing your daily care tasks.
Diet
After breaking a bone you need a healthy diet so you can get the right vitamins and nutrients that your bone and wound need to heal. What you eat will be checked by the nurses and if they are worried they will ask a dietitian to see you.
Tips for a healthy recovery:
· Aim to drink six to eight glasses of fluid a day. This can include water, juice, tea and coffee but be careful not to drink too many caffeinated drinks as they can make you need the toilet.
· After you are discharged from hospital eat lots of calcium rich foods e.g. milk, cheese, yoghurt, green vegetables and bread.
· Make sure you have enough vitamin D, from oily fish, supplements or sunlight.
If you need any further help with what you should eat please just ask and we can provide more information.
Falls and bone health
A hip fracture normally, but not always, is caused by having had a fall. As we get older, bone is lost more than it is re-built and so the skeleton becomes weaker. This can mean that bones break more easily.
If you have fallen, you may be afraid of falling again, and this can sometimes limit your confidence and your ability to move around. If you do have a fear of falling please let one of the team know so we can help with this.
We can help with:
· further investigation of why you fell
· checking your strength and balance
· checking your medications
· checking your eyesight
· teaching you what to do if you were to fall again
· advice on how to prevent falls
· referral to a falls group or exercise class.
Osteoporosis
Osteoporosis is a condition where bones lose strength and can break more easily.
The following can make you more at risk of developing osteoporosis: