What is a Broken Hip?

A broken bone in your hip. You may hear your injury called a FRACTURED NECK OF FEMUR.  A broken hip can occur for many reasons—whether you fell over the cat, trip on a mat, have a problem with balance, or thinning of the bones (OSTEOPOROSIS).

You may be admitted to the Surgical Ward.

The picture below gives you an idea of what your hip looks like.  The areas of the hip that can break, or fracture, are shown.

 

The Operation

The operation can be called an ‘open reduction and internal fixation’.  This means that the surgeon will make an incision (cut) over the hip area and bring (unite) the broken bone ends using either metal pins, plates or screws.

In some cases a part of the hip—called the head of femur—may need to be replaced with a metal ball shaped part.  This operation is called a hemiarthroplasty.

 

Before the Operation

You will remain on bedrest. 

As you will not be moving around much, you may have injections prescribed for you.  These injections help reduce the risk of blood clots.

You will not be able to eat or drink anything in the 12 hours before your operation.  A drip (intravenous therapy) will be started so that you do not become dehydrated.

You will be given regular pain relief.  Let the nurse know when you are feeling pain.

Your Orthopaedic Doctors will discuss the operation with you, as well as the best option.

A pillow may be placed under your leg to provide extra comfort

How Long Does The Operation Take?

The operation will take around 1 ½ hours.  You will spend another 1-2 hours in the recovery ward where your observations—blood pressure, pulse and breathing rate—are monitored.

When your observations are stable you will be transferred to the surgical ward. 

After the Operation

When you wake up after the operation you will have:

• An oxygen mask over your nose and mouth
  
• A drip in your arm to give fluids and antibiotics
  
• May have a Drainage tube(s) from your hip wound

Your observations will be taken regularly for the first 24– 48 hours.

Your operated leg will be checked for warmth, colour, movement, and sensation /feeling.  YOU SHOULD TELL THE NURSE IF YOU HAVE TINGLING, SORENESS; NUMBNESS in your toes, leg or heel.

A pillow may be placed under your leg for support and comfort

You will be encouraged to do deep breathing and coughing exercises

 You will start on a light meal and progress to regular meals when you feel comfortable.

The nurse will assist you to reposition yourself for comfort and to encourage pressure relief.

A urinary catheter (tube into your bladder to drain urine into a collection bag) will stay in for 1-2 days after the operation.

DAY ONE

The Orthopaedic doctors will check on your progress every day.

You will be helped to change your position while in bed to relieve pressure on your back. The nurse will assist you to have a wash in bed

The nurse will continue to check your observations regularly
 
The drip in your arm will continue until you are tolerating fluid (water) and food.

If you have a drainage tube from your hip then it will be removed today

You will be given regular pain relief if your pain is not relieved please let the Orthopaedic team know, it is important to control your pain and take medications prior to exercising and walking.  Taking regular pain relief tablets will assist you in actively participating in your rehabilitation.
It is important to tell the nurse if you are constipated or if you take regular bowel opening medicines.  Pain relief medications will cause constipation.

Your hip dressing will stay intact (for up to 7 days) unless—it has been leaking and needs to be changed

If comfortable you may sit out of bed today, with the assistance of the Physiotherapist or nursing staff.
You will need to walk with a walking frame to start with—called the Forearm Support Frame (FASF– pictured below). 

Day 2—After Your Hip Operation

Your hip dressing will stay intact unless—it has been leaking and needs to be changed

Your observations will be regularly checked

You will be helped onto a shower chair (commode) and given help to shower.  You will be encouraged to clean your own teeth / dentures and comb your hair.

You will be seen by different Health Care Team Members who will review your progress and plan what care you may need in hospital and when you go home.  Some of these people include the Social Worker, the dietician, and the Doctors who will arrange your rehabilitation (Orthogeriatrician).

You will begin to walk around the ward and will sit out of bed in a chair for short periods.

A quick return to walking is essential to guard against possible complications of staying on bed too long such as urinary infections, pneumonia, bedsores, blood clots and muscle wasting/ weakness.

Day3—After Your Operation

Your observations will continue to be checked

You will be assisted to shower yourself

Your wound dressing will remain intact and checked by the nurse regularly.  It will only be changed when necessary

Your pain relief will be reviewed daily. 
The aim of pain relief is to make you as comfortable as possible and allow you to continue your exercises and walking

When you sit in the chair—for longer periods—you will be assisted to stand up to help relieve pressure off your bottom.  It is important that you move (reposition) yourself regularly when sitting in a chair or in bed.

You will walk further distances.  As your walking improves you will progress to a different walking aid—such as a Pick up Frame or Crutches.

Ongoing Care In the Acute Ward

At all times you (and your family) are encouraged to participate in your care decisions and planning.

Each day work with the Nurses and Health Professionals to promote independence.

 Pressure Area Relief

Patients with broken hips are at risk of developing pressure sores (bedsores).  It is important to regularly reposition yourself, the nurse will assist in the first couple of days, suspend (elevate) heels off the bed with a pillow for different intervals throughout the day to relieve pressure, when sitting, reposition (move) yourself regularly to reduce pressure.

Pain Relief

You will be prescribed regular pain relief tablets you can also ask the nurse for more pain tablets if you feel your pain is not under control. Remember pain is an individual experience, and everyone has a different level of pain tolerance.

The aim of pain relief is to make you as comfortable as possible and allow you to continue your exercises and walking

You will be seen by different Health care team members who will review your progress and plan what care you may need in hospital and when you go home.

Some patients find they become constipated when on strong pain relief, so tablets will be given to prevent such events.

Preventing Blood Clots

Each day you will have an injection into your belly. The aim is to thin the blood and reduce the incidence of blood clots in your legs.  You will also be fitted for antiembolic stockings (white stockings). They are specialised elastic stockings that will assist the circulation in your legs and help reduce the risk of blood clots.  You will wear these stockings until you are able to walk around as independently as you were before your broken hip (usually 6 weeks)

Wound Care

You will have a waterproof dressing on your hip, this dressing can stay intact up to one week after your surgery.  The Orthopaedic team will review your dressing before you are discharged from hospital.  If you have sutures (stitches) to be removed the nurse will let you know

Before Being discharged home you need to be as independent as possible. For Example:
you may need to be able to walk safely with your walking aid.
You need to be reasonably comfortable when moving around, sitting and when standing from the sitting position
Can manage to do activities with equipment/ aids given by the Occupational Therapist ie. Shower chair
You may have support at home—for example: family or friends can help with shopping, services such as homecare for cleaning or meals on wheels can be arranged to help you when you go home

Going Home

Depending on your progress and the level of independence you had before your broken hip, you may be able to go straight home from hospital, sometimes people require a period of rehabilitation. 

Most patients are in the Surgical Ward for 5 –7 days and then are either transferred to a Rehabilitation Facility or Transferred Home.

If you are from a Nursing Home then you are discharged to the nursing Home about Day 3 after your operation.

This booklet is only a guide.

It is intended to answer some of the commonly asked questions about HIP FRACTURES—a break in the hip bone. 
We feel that a patient who is better prepared to participate in their rehabilitation is more likely to gain full benefit from their treatment.

Orthopaedic Department: Concord Hospital SSWAHS.