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hip fractureOrthopedic surgery A femoral fracture which affects 1/6 white ♀–US during life Epidemiology 250,000/yr–US Specifics Proximal femur; 90+% femoral neck, intertrochanteric; 5-10% are subtrochanteric Risk factors Tall, thin ♀, osteoporosis, previous Fx or stroke, white, use of walking aids, alcohol consumption, poor health, sedentary lifestyle, Rx with benzodiazepines, anticonvulsants; HRT may protect ♀ < age 75, institutional residence, visual impairment, dementia Diagnosis Hx, plain AP film, MRI, 99mTc bone scan. See Falls, Total hip replacement.
hip frac·ture(hip frak'shŭr)
Osteoporosis predisposes an elderly person to hip fracture.
Pain in the knee or groin is the classic presenting sign of a hip fracture. If the femur is displaced, shortening and rotation of the leg may be present.
Preoperatively, Buck's traction may be used in the short term to alleviate muscle spasms. An open reduction is the preferred surgical treatment. A femoral prosthesis may be used for femoral neck or head fractures. The bone takes 6 to 12 weeks to heal in an elderly patient.
During hospitalization, general patient care concerns apply. The patient is prepared physically and emotionally for surgery according to the orthopedic surgeon's protocol, and postsurgical care and pain control (epidural or intravenous patient-controlled analgesia [PCA]) is discussed. Neurovascular status of the affected limb is assessed according to protocol and compared to the unaffected limb. The patient is referred for physical and occupational therapy and uses a walker until the bone is completely healed. Prevention and relief of pain and monitoring of postoperative complications, including infection, hip dislocation, and deep venous thrombosis or pulmonary embolism, are primary concerns. Use of an incentive spirometer is encouraged to prevent atelectasis and respiratory complications. Prophylactic antibiotics and anticoagulants are administered as prescribed, and hip precautions are implemented to prevent dislocation. These precautions include having the patient avoid hip adduction (usually by an abductor wedge), rotation, and flexion greater than 90° during transfer and ambulation activities, and by using a raised toilet seat and semi-reclining chair. The patient is typically hospitalized for 2 to 4 days and then discharged to a nursing home, subacute unit, transitional care unit, rehabilitation center, or home for rehabilitation for several weeks.