Hip fracture

A hip fracture is a serious injury and it may take patients a long time to recover. This information aims to help you understand more about your injury and the treatment options available. It has been created by nurses, doctors, physiotherapists, occupational therapists, dietitians and social workers. These staff will work with you while you are in hospital.

Your plan for discharge will start after your surgery and will be discussed in partnership with you and your family/carer. The team recognises that communication with family/carers is important, however your confidentiality is always maintained. If you or your family/carers have any questions, please do not hesitate to ask the staff caring for you

What does a hip joint look like?

Your hip is a ball and socket joint, located where your thigh bone (femur) meets your pelvis (acetabulum). When you break your hip, it is referred to as a hip fracture or ‘fractured neck of femur’.

What will happen when I am admitted to hospital?

You are likely to have arrived at the hospital via the Emergency Department and may need the following:

• an x-ray of your hip and chest (if needed)
• blood tests
• pain relieving medication, and later an injection into your groin to stop the pain in your hip
• a catheter to drain the urine from your bladder
• your urine will be tested
• an intravenous (IV) drip inserted for fluids
• an ECG heart tracing
• your blood glucose level measured
• you may need to answer questions about your medications, allergies, or special diet requirements
• you may need to answer questions about your general health, awareness, memory and recall
• put you on a pressure relieving bed to make you feel more comfortable and prevent you from getting bed sores
•  asked your relatives or carers (if they are with you) about your general ability to cope at home (if required).

You will need to stay in hospital. Most hip fractures require surgery and we aim to fix your hip within 48 hours of injury, or when it is medically safe to do so.

What will happen before my surgery?

Anaesthetics
The anaesthetist will see you before your surgery and will discuss the types of anaesthetic most suitable for you. This may be a general anaesthetic (asleep during the operation) or a spinal (awake during the operation, but numb from the waist down to prevent pain—you may also have some sedation).

Consent
The orthopaedic doctor will explain the proposed operation to you including the risk and

benefits of the procedure so that you can make an informed decision about your care. You will be asked to sign a consent form.

Note—the patient’s next of kin (with an Enduring Power of Attorney [EPOA]), or a guardian will be asked to sign the consent on the patient’s behalf, if the patient is unable to provide informed consent. All paperwork verifying the EPOA or Guardianship must be seen by the treating team.

Nil by mouth or ‘fasting’
You will need to fast before surgery: your doctors and nurses will tell you when you have to stop eating and drinking.

Your other medical needs
A senior doctor, specialising in care of the elderly, will see you to assess your overall health needs. They will supervise your ongoing care while you are in hospital and assess your future risk of falls and fractures. They may recommend changes to your medications and will let your GP know what these changes are when you leave hospital.

A dietitian or nutrition assistant will assess you within 48 hours. They will discuss your dietary needs with you both while you are in hospital, and after discharge.

Other medical concerns

Chest infections
There is an increased risk of a chest infection after surgery, particularly if you have a history of chest problems or if you smoke. If you have any issues, you may need chest physiotherapy and medications.

Pressure sores

• A pressure sore is an ulcerated area of skin caused by irritation or continuous pressure on a part of your body, usually because you are unable to move as much as you normally would.
• You will have a pressure relieving mattress and your skin will be assessed frequently.
• The nursing staff will reposition you at regular times if you are unable to move in bed.
   

Confusion
Acute confusion can occur in up to 50% of patients after a hip fracture and can occur several days after surgery. We will monitor you and manage any increase confusion. Most confusion will get better with time. Agitation can be reduced by having carers or family members present. It is helpful to get family/carers to write things down and find alternative ways to communicate. Documenting your likes and dislikes on a sunflower chart above your bed will help us to get to know you even if you are agitated or confused.

National Hip Fracture Registry

The hospital takes part in a hip fracture database, which has been set up to help improve the services for patients with a fractured neck of femur. The information collected is anonymous and confidential.
Please let a member of staff know if you do not wish to participate.

What type of surgery will I need?

There are several different operations to repair or replace a fractured neck of femur (see below). The type of operation your surgeon chooses depends on the exact location of the fracture and if the blood supply to the bone has been disrupted.

Hemiarthroplasty
A hemiarthroplasty is a partial hip replacement. This type of surgery is used for fractures which occur near the hip joint. The surgery replaces the broken half of the hip with an artificial ball. The socket portion of the hip is left alone.

Total hip replacement
A total hip replacement is like the hemiarthroplasty procedure, but both the ball and socket portions of the hip are replaced with artificial implants.

Sliding screw procedure
A sliding screw procedure is used for fractures that are further away from the hip joint. A screw is inserted into the head of femur which bridges the broken hip bones while they are healing. A metal plate holds the screw in place; this is then secured onto the side of the femur by several smaller screws.

Intramedullary nail
An intramedullary nail is used for fractures that are further away from the hip joint, mostly those down the thigh bone. This procedure involves an intramedullary nail, which is a metal rod, inserted down the middle cavity of the thigh bone. The metal rod is then held in place with small screws. This type of procedure is permanent, and the metal rod will stay in place even after the fracture has healed.

Screw fixation
A screw fixation is where the fracture is fixed with individual screws. The screws are placed into the neck of femur to secure the broken bones as they heal; usually two or three screws are needed.

What happens after my surgery?

After your surgery and when the anaesthetist/ nurse is happy with your recovery from the anaesthetic, you will be transferred to the ward. The day after surgery, you will have an x-ray to check the repair to your hip and you will have a blood test.

Moving around after surgery

• Early movement and exercises will help reduce any stiffness and pain and prevent blood clots in your legs or lungs. This can also help you to recover more quickly.
• You may require walking aids and assistance with walking after surgery.
• The physiotherapy team will help you with getting out of bed, into your chair and moving around. This may be as early as the day after surgery, even if it’s a weekend. It is important to take your regular prescribed pain medication, so you can move about comfortably.
• The physiotherapists and the occupational therapists will assess your activity level before you broke your hip and assist you in reaching the same level of activity as you were before if possible. The physiotherapist will also give you exercises to do at home.

Pain management

• The anaesthetist will discuss the plan for managing your post-operative pain with you/your family/carer before your surgery. Usually this involves a drip with pain relieving medicine, and then oral tablets once the drip is removed.
• After your surgery, the anaesthetist will review your pain management plan every day to ensure you are comfortable and able to move as allowed.
• You will go home on medications prescribed by your doctor.
   

Constipation
Strong pain-relieving medications, limited mobility and reduced appetite all contribute to constipation after the operation. This is normal, but you should tell the nursing staff if your bowels have not moved or you feel uncomfortable. You will be given medicines to treat this if required and the dietitian can help ensure that your diet includes some fibre.

Getting back to normal

Usual activity

• While we try to get you back to your normal level of activity, sometimes this is not always possible. We may need to discuss with you the possibility of rehabilitation, or even residential or nursing home care.
• Staff will involve you and your family/carer in all discussions about this.
• You may need an occupational or physiotherapy home assessment prior to discharge to ensure to that if you are going home you will be able to manage.
• A social worker may also provide advice on more complex support requirements.

Healthy bones
While you are in hospital, we will assess your risk of further fractures. You may need to start taking long-term bone strengthening medicines. Your GP will be asked to arrange a bone scan and manage your long-term treatment. This usually includes calcium and vitamin D supplements and medications to slow down bone loss.

Discharge
The ward team will be planning for your discharge (in partnership with you and your family/carer) as soon as you can manage tasks safely. This could mean going home with some supports or going to a rehabilitation hospital or even nursing home care. Your discharge needs may change as you improve. Once you are discharged it is important to keep up with your pain medication and physiotherapy exercises. You should be able to get back to your normal activities gradually, as you feel able.

Share this page