HIP FRACTURE |
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General Information
DEFINITION--A complete or incomplete break in the head of the femur, the major bone in the hip joint.
BODY PARTS INVOLVED
Femur (the large bone extending from the knee to the hip).
Acetabulum (hip socket in bony pelvis).
Hip joint.
Soft tissue around the fracture site, including muscles, nerves, tendons, ligaments, periosteum (covering to bone), blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Severe pain in the hip.
Inability to stand.
Swelling and bruising around the fracture.
Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal body contours.
Tenderness to the touch.
Numbness or coldness in the leg and foot if the blood supply is impaired or nerves are injured.
CAUSESDirect blow or indirect stress to the hip joint. Indirect stress may be caused by twisting or a violent muscle contraction.
RISK INCREASES WITH
Adults over 60.
Contact sports.
Cycling.
History of bone or joint disease, especially osteoporosis.
Obesity.
Poor nutrition, especially insufficient calcium and protein.
If surgery is needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build your strength with a good conditioning program before beginning regular athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Use appropriate protective equipment, such as hip pads, when competing in contact sports.
Ensure an adequate calcium intake (1000mg to 1500mg a day) with milk and milk products or calcium supplements.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment.
Hospitalization for anesthesia and surgery to set the broken hip fragments, usually by surgically pinning them together.
Physical therapy and rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the hip, ankle and pelvis.
POSSIBLE COMPLICATIONS
AT THE TIME OF FRACTURE:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, blood vessels or connective tissues. AFTER TREATMENT, INCLUDING SURGERY:
Excessive bleeding.
Impaired blood supply to the healing bone.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Problems arising from plaster casts, splints or other immobilizing materials. See Appendix 2 (Care of Casts).
Shortening or deformity of the fractured bone.
Poor healing (non-union) of the fracture.
Arrest of bone growth in young people.
Infection introduced during surgical treatment.
Unstable or arthritic hip joint following repeated injury.
PROBABLE OUTCOMEThe average healing time for this fracture is 6 to 8 weeks. Healing is considered complete when there is no pain or motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Cut away clothing, if possible, but don't move the injured area to do so.
Use a padded splint or backboard to immobilize the hip joint before transporting the injured person to an emergency facility.
Apply ice packs to the injury site to decrease swelling and pain.
Elevate the foot of the backboard or splint so the pelvis is above the level of the heart. This reduces swelling and fluid accumulation.
Keep the person warm with blankets to decrease the possibility of shock.
The doctor will manipulate and set broken bones during surgery. Manipulation should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose elasticity and become difficult to return to a normal position.
CONTINUING CARE
Immobilization will be necessary. In hip fractures, the fractured bone is usually fixed and held with surgical steel pins or nails. A rigid cast is placed from pelvis to knee.
Use frequent ice massage after the cast is removed. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
General anesthesia to make joint manipulation possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen for mild pain.
Antibiotics to fight infection following surgery.
ACTIVITY
Begin reconditioning and rehabilitation after clearance from your doctor.
Resume normal daily activities gradually after treatment.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a hip fracture. Call immediately if you have numbness or loss of feeling below the fracture site. This is an emergency!
Any of the following occurs after surgery:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Nausea or vomiting.
Swelling above or below the cast.
Blue or gray skin color beyond the cast, especially under the toenails.
Constipation.
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