A broken femur, often called a hip fracture, is a serious and life-altering event for older adults. This injury typically results from a low-energy fall in individuals whose bones are weakened by osteoporosis. Over 95% of these fractures are caused by falling, presenting a significant health challenge due to high rates of associated illness and mortality. Rapid identification and treatment are necessary to mitigate serious complications and start the journey toward functional independence.
Acute Treatment Decisions
The immediate medical response focuses on pain management, patient stabilization, and preparing for intervention. Surgical treatment is recommended for most elderly patients, ideally performed within 24 to 48 hours of admission. This swift action reduces patient immobility, preventing complications like pressure sores, pneumonia, and blood clots.
The choice of operation depends on the fracture location and the patient’s pre-injury health status. Extracapsular fractures are typically treated with internal fixation, using devices like plates or screws to stabilize the bone. Intracapsular fractures often disrupt the blood supply to the femur, increasing the risk of non-union or bone death.
For displaced intracapsular fractures, a partial or total hip replacement (arthroplasty) is often the preferred treatment, offering better functional outcomes and a lower rate of reoperation compared to internal fixation. Non-surgical management, involving pain relief and immobilization, is reserved for patients with severe co-morbidities where surgical risks outweigh the benefits. However, non-operative treatment is associated with significantly higher one-year mortality rates, underscoring the importance of a surgical approach whenever feasible.
Managing Unique Complications
The period immediately following an operation carries heightened risk due to the combined stress of trauma, surgery, and immobility. Systemic complications frequently occur within the first two weeks after the procedure.
Common Post-Operative Issues
- Urinary tract infections and pneumonia, often linked to reduced mobility and catheter use.
- Post-operative delirium, an acute state of confusion, which hinders participation in early rehabilitation.
- Venous thromboembolism (DVT/PE), resulting from lack of movement.
- Surgical site infections, which tend to appear later, often 11 to 24 days post-operation.
Managing pre-existing chronic illnesses, such as diabetes or heart failure, becomes complex during recovery. These co-morbidities influence anesthesia and medication choices, and their destabilization can lead to serious adverse events like stroke. Malnutrition is also widespread, contributing to poor wound healing and a higher risk of complications.
Navigating Rehabilitation and Recovery
Rehabilitation starts almost immediately following the operation to prevent muscle atrophy and complications from prolonged bed rest. Physical and occupational therapy teams aim to get the patient moving and bearing weight as soon as the day of or the day after surgery, depending on the fracture type and repair. The goal is to progress from the acute care hospital to a post-acute setting.
The next step involves transitioning to a skilled nursing facility or an inpatient rehabilitation hospital for intensive, structured therapy. Inpatient rehabilitation focuses on regaining the strength and range of motion necessary for mobility and activities of daily living. Patients who had an arthroplasty or extracapsular fracture fixation can often begin immediate weight-bearing, while others may need a period of protected weight-bearing.
This intensive phase lasts for several weeks, focusing on safe movement with assistive devices like a walker, progressing to a cane. Once the patient can manage basic self-care and mobility tasks, they may transition to a home health program or outpatient therapy. Complete functional recovery, meaning a return to the pre-injury level of mobility, is a long-term process that can take six months to a year. Consistent participation in the prescribed therapy program is important for achieving the best outcome and reducing the risk of a subsequent fall.
Restoring Mobility and Preventing Future Injuries
Once the patient returns home, the focus shifts to maintaining therapeutic gains and preventing injury recurrence. Home safety modifications are a practical first step, including installing grab bars, ensuring adequate lighting, and removing tripping hazards. These adjustments support restored mobility and build confidence.
Nutritional support is important for long-term bone health and muscle strength. Dietary intake should be optimized for protein to rebuild muscle mass lost during immobility. Supplementation with Calcium and Vitamin D is often recommended to strengthen bone density, especially in patients with osteoporosis.
Ongoing, gentle exercise is important for maintaining balance and coordination, directly addressing the underlying cause of the initial injury. Addressing the fear of falling is necessary, as this fear can lead to reduced activity, muscle weakness, and increased fall risk. Regular medication reviews can help adjust medications that cause dizziness or unsteadiness, further supporting safe, independent mobility.