For an elderly person, a fall can be a devastating experience. A fall happens to one in every three senior citizens, making it the leading cause of injuries in people over 65. Many times, a fall will result in a hip fracture, with senior citizens accounting for 90 percent of all hip fractures. This fracture occurs due to a break in the hipbone, usually the upper part of the thighbone. Because older women lose bone density due to menopause, they suffer hip fractures at a higher rate than men.

Many older adults have difficulty fully recovering, even after treatment and rehabilitation. Almost half of those with a hip fracture will require a walking aid. Some seniors fall and suffer from a fracture due to physical or mental disabilities, requiring long-term care and assistance.

 

The most commonly seen hip fractures in elders happen in the femoral neck and intertrochanteric regions. A femoral neck fracture occurs between the femoral head, or ball, and the femoral shaft, or thighbone. An intertrochanteric fracture occurs along the line of the femur connecting the hip muscles.

The cause of these fractures is not limited to a fall. A fracture can happen even through minimally stressful activities such as rolling over in bed, getting up from a chair, or walking. The symptoms include:

• Severe pain in the hip or groin

• Immobility after a fall

• Inability to put weight on the injured leg

• Shorter appearance of the injured leg, with foot and knee turned outward

• Stiffness, bruising or swelling in the hip

 

A hip fracture is usually confirmed through X-rays. Surgery is almost always the first line of treatment, except in cases where the patient’s health and age create too high of a risk. In the case of nonsurgical treatment, a person will be put into traction (a tension system) and confined to a bed. Traction will keep a patient immobile for a lengthy period of time.

Types of surgery include:

• Repairing with metal screws: If the bone is still aligned metal screws are inserted to hold it in place until the fracture heals. For additional stability, bone nails (gamma nails) are also used. This is also known as internal fixation.

• Replacement of part of the femur: In cases where the ends of the bone are broken and alignment is lost, the head and neck of the femur are replaced with a metal prosthesis (artificial joint). This is known as hemiarthoplasty.

• Total hip replacement: With a total hip replacement, the upper femur and socket of the pelvic bone are replaced with a metal prosthesis. This is a recommended surgery for people with joints damaged by arthritis. The likelihood of total hip replacement depends upon the nature of fracture, severity of symptoms, personal risk, and degree of mobility prior to the facture.

Post-surgical Recovery

Normal recovery from hip surgery will have the patient rehabilitating as soon as approved by the orthopedic surgeon.. Physical therapy will initially focus on range of motion and strengthening exercises. Eventually, the patient will be coaxed to move with the help of a walker.

Surgery and time spent in a hospital generally last less than a week. After that, the patient can be offered an extended care facility if they do not have help at home. After a several weeks, an occupational therapist teaches the patient to perform everyday activities independently, such as using the toilet, bathing and dressing.

A hip fracture is a serious injury. At times, life-threatening complications can occur. When traction is applied instead of surgery, it can lead to following issues:

• Muscle deterioration and weakness

• Risk of permanent loss of mobility

• Risk of developing blood clots (thrombosis)

• Risk of emboli (traveling blood or fat clots)

If a patient is immobile for long periods of time, it is possible for a blood or fat embolus to become lodged in a pulmonary artery blocking blood flow to the lungs. This results in pulmonary embolism, which can be fatal. Other complications as a result of immobility include bedsores, urinary tract infection, and pneumonia.

For anyone who has suffered a hip fracture always runs a high risk of another fracture. In those patients who have undergone total hip replacement, the average life expectancy of an artificial hip joint (prosthesis) is 10 to 15 years. After that time, a hip revision surgery may be necessary, due to looseness of the joint or infection.

Over 60 percent of falls happen in the home. Preventing these falls is very important, especially in senior citizens with low bone density. Multiple factors contribute to a fall; taking medication with side effects that affect balance and judgment, drinking alcohol, taking sedatives, and conditions that affect balance like Parkinson’s disease.

Precautions can be taken in the home to make it a safer place:

• Floors: All loose wires, rugs and any clutter should be removed

• Bathrooms: Bars should be placed in the shower for balance and non-skid tape or pads placed in the tub or shower

• Lighting: Halls, stairways, and entrances must be well-lit

• Kitchen: Clean any spills immediately and keep non-skid mats near the sink

• Stairs: Make sure railings are secure

• Exercise: Improves balance, strength, coordination, and flexibility, which makes mobility easier

A healthy diet can also help keep bones strong. Eating and drinking products high in calcium such as milk, yogurt, and cottage cheese will keep a person’s bones strong. Additionally, taking vitamin D helps the body absorb calcium. Sunlight exposure 10 to 15 minutes, twice a week is a simple way to ensure adequate levels of vitamin D. Wearing proper, rubber-soled footwear and avoiding risky behavior that can lead to falls is also important.

It is extremely important for post-menopausal women to have their bone density examined periodically to check for osteoporosis (brittle bones). Along with calcium and vitamin D supplements, other medications may be prescribed by your physician to prevent or treat osteoporosis and decrease the likelihood of a hip fracture.

Road to Recovery

The main goal of surgery is to regain mobility and activity in a person’s daily life. By following the physical therapist’s instructions and taking the necessary precautions to prevent further falls, recovery will be faster. Be mindful that healthy lifestyle choices will significantly reduce the risks of fracture recurrence.