With one in three elderly people suffering from osteoporosis, fractures of the femoral head and neck are very common. The complications of such a fracture range from pain and inconvenience of a hospital stay to months of rehabilitation and loss of independence to death either from the fracture or from complications of the surgery needed to correct the fracture.
In almost all cases, surgery is required to stabilize the fracture with internal fixation. Even if the patient was previously immobile, surgery will help with pain relief and nursing management of a bedridden patient. Nowadays, most of the surgical procedures will be performed under a spinal anaesthetic. This is less likely to cause problems in patients, many of whom will have multiple health complaints. Nevertheless, any anaesthetic can cause problems with mental functioning and in combination with the trauma of the fall and change in environment, many patients can become confused and agitated.
Like all surgical procedures, there is risk of infection and haemorrhage. Infection in bone, especially when associated with metal implants, can be life threatening and carries a huge burden of morbidity. Haemorrhage can occur at the time of operation or afterwards and is more likely if patients are taking blood thinning agents such as aspirin or warfarin. Many patients will have come from less than ideal home circumstances and their state of nutrition may be sub-optimal. This will increase their risk of infection and also retard their progress post-operatively.
There is also a risk of post-operative deep venous thrombosis or pulmonary embolus and patients are encourage to mobilise early to reduce this complication. Following the surgical procedure, patients will need to undergo extensive rehabilitation to regain their mobility. Some will be able to return home with little more than a walking stick or frame. However, many will not be able to return home without adequate supervision and if this is not available, other accomodation will need to be considered.
Most hip fractures occur in the elderly and are caused by falls. In some cases, a review of medication will reveal a combination that has contributed to a loss of balance. It is important that all medications be re-assessed. it is also vital that a home assessment is done prior to discharge. Rugs on slippery floors, inadequate lighting, absence of rails in bathrooms and bedcovers that drape onto the floor can all be factors in causing falls. Unfortunately, for elderly people, the consequences can be life-changing.