Learning Objectives     1. Define hip fracture.     2. Describe the process of recovery and rehabilitation from hip fracture.     3. List at least 6 safety tips to avoid hip fractures.

Fran Smith, 78, fractured her hip last night. Her hospital admission physical exam revealed osteoporosis. Fran asked her doctor what to expect in terms of recovery. The doctor assured Fran that, in time, she would be able to get back on her feet and return to independent living. The doctor did stress that treatment, participation in rehabilitation activities, and a positive attitude are important for a successful recovery.

Definition

A hip fracture is a broken bone near the top of the femur or thighbone. The femur is the long, straight bone that runs from the knee to the hip joint. The top of the femur angles in towards the body where its rounded ball-shaped end fits into a C-shaped cavity in the pelvic bone. This kind of joint is called a ball and socket joint. The hip most commonly fractures near the top of the femur or at the angle where the bone connects to the body.

An operation is usually necessary to repair a fractured hip. The surgeon repairs some fractures by inserting a pin to hold the bones together while they heal. Other fractures require a hip replacement which is done with a prosthesis or artificial ball and/or joint socket.

Recovery and Rehabilitation

After surgery, rehabilitation begins so that standing, and attempting to walk are possible in the first week. At this time, your doctor may prescribe medications to prevent further bone loss as well as appropriate amounts of calcium and vitamin D.

If you are sent home after surgery, you may have frequent, scheduled appointments at home with specialists such as physiatrists, doctors who specialize in physical medicine and rehabilitation, visiting nurses, physical therapists, and occupational therapists. If you are being discharged to your home, you may remain in the hospital from one to three weeks before discharge. If you are discharged to a rehabilitation facility, your hospital stay may be shorter.

If there is no one to help you at home, you may be sent to a rehabilitation facility or nursing home. Here, people will help you learn to care for yourself again. As you become stronger and more mobile, you may continue physical therapy as an out-patient, coming into the hospital or rehabilitation facility daily or several times a week to ensure continued progress.

You will begin physical therapy immediately after surgery. Physical therapists focus on getting you back on your feet even though you feel unsteady and initially it hurts to move. You will do exercises to increase the strength, flexibility, and stamina of your hip muscles. In the beginning, you may need to use a wheelchair to get around. As you get stronger and the pain decreases, you will graduate to a walker, crutches, or a cane. Physical therapists will instruct you on walking with the aide of crutches, a walker, or a cane, getting up and down stairs, maneuvering around obstacles in your home, and getting into and out of a car. By the end of three months, you may need assisted devices only occasionally.

Occupational therapists teach you how to dress, bathe, and care for your personal needs and can assess your home environment and identify appliances and aids to help you function independently. They can also make recommendations that make your home environment safer for you. Some changes may include a chair or grasp rails in the tub, removal of scatter rugs, and the substitution of a tall, high-backed chair instead of a low, soft easy chair.

Recovery from a hip fracture can take four to eight months. In the early weeks of rehabilitation, your activities will be limited, and you will need to rely on others for shopping, cooking, cleaning, bathing, and even dressing yourself. For some people, acknowledging how dependent they are on others is very hard. No one else does things the way you do, and this may cause frustration and friction in the best of families. Hopefully, the people helping you will be sensitive to how you feel about being so dependent, but you need to remind yourself that this is only temporary.

According to rehabilitation studies, recovery is positively

affected by a strong social support system, living with others, and being able to go shopping or visiting outside the home even once a month. Although pain, fear, and depression are common following a hip fracture, your ability to fight these negative feelings and maintain a positive attitude can help move your recovery forward. You may have periods of feeling very tired or weak. At these times it's important to look back over all the progress you have made.

One important mental exercise to do every day is to repeat positive steps to yourself. Unfortunately, we are more comfortable telling ourselves negative things like "I'll never be able to walk like I did before," or "It hurts too much." Instead, try telling yourself, "I walked 10 steps further today than yesterday." "I was able to make breakfast today." "I will go to the hairdresser next week." Remember that all the small steps add up when you're recovering from a broken hip. Write down at least one positive change everyday. It may deal with exercising, walking, doing an errand, going to a movie, or even putting away the breakfast dishes.

If you continue to feel depressed, ask your doctor, hospital discharge planner, or rehabilitation facility for a referral to a knowledgeable counselor. A few counseling sessions may help you to feel more positive about your recovery.

Safety

Since many hip fractures result from tripping, slipping, or loss of balance, fall-proofing the home, balance training, and exercises to increase muscle strength should be part of the rehabilitation process. As people age, they move more slowly, their reflexes are slower, and they are less able to catch themselves once they start to fall. Also, medications for existing medical conditions may affect balance, vision, or sensations in the feet.

You can reduce your risk for falling by having regular physical exams, including vision and hearing tests, and by reviewing with your doctor the medications you are taking. Avoid alcohol, and wear sturdy, low-heeled shoes. Also, balance training can help you improve your posture, control your body position and coordination, and increase muscle strength and joint flexibility.

Source: National Osteoporosis Foundation

Reprinted with permission