Fractured Hip

1. Definition of "hip fracture."

1. It is a fracture of the bone or bones that make up the hip (a ball and socket-type joint).

2. There are two types of hip fractures.

1. Intracapsular (fracture inside the joint).

2. Extracapsular (fracture outside the joint).

3. Open reduction internal fixation (insertion of pins or nails, insertion of screw plates, or hip prosthesis) surgery may be performed.

2. Factors that increase the risk of a hip fracture.

1. Advanced age.

2. Osteoporosis.

3. Prolonged immobility.

4. Poor nutrition.

3. Signs and symptoms of a hip fracture.

1. Shortening of affected extremity.

2. Severe pain and tenderness.

3. Prolonged immobility.

4. Inability to bear weight.

4. Typical activity orders related to a hip fracture.

1. Avoid flexion of hip beyond 90 degrees. (Avoid putting on own shoes and stockings until at least eight weeks after surgery.)

2. Never cross legs or squat.

3. Bear weight on affected leg only as ordered.

4. Use toilet elevator on toilet seat to ease transfers.

5. Use pillow between legs to sleep for the first eight weeks after surgery.

6. Avoid sleeping on operative side.

7. Lie on stomach for fifteen minutes every day.

8. Follow progressive exercises as ordered.

5. Typical orders related to care for incision.

1. Cleanse wound as instructed, and keep a dry, sterile dressing over incision until healed.

2. Report any signs of infection such as fever, redness, odor, painful swelling, and drainage.

6. General post-operative orders.

1. Wear elastic stockings as ordered to prevent embolism.

2. Follow safety precautions to prevent falls, such as handrails, well-fitting shoes, good lighting, avoiding clutter, etc. (Refer to Safety/Potential for Injury to the Elderly Teaching Guides.)

7. Possible complications of a hip fracture.

1. Incisional infection.

2. Displaced prosthesis or pin.

3. Thrombophlebitis.

4. Emboli (blood clot that travels to lung or brain).

5. Shock and hemorrhage.

6. Contractures.