Johns Hopkins Health Alert
Talking About Hip Fractures with Dr. Bellantoni
In this Health Alert Michele F. Bellantoni, M.D., associate professor of medicine and medical director of the Johns Hopkins Bayview Care Center, discusses why hip fractures can be so difficult for older people and what you can do to help ensure a successful recovery.
A hip fracture is a potentially life-threatening injury, especially for older adults. Approximately 25 percent of people over 50 who fracture a hip die within the first year of the injury; another 60 percent are unable to perform common activities such as bathing, dressing, and cooking. The stress of caregiving can be hard on spouses, too. In fact, a recent study of Medicare recipients, published in The New England Journal of Medicine, found that spouses of people hospitalized for hip fracture were 15 percent more likely to die within a year of the event.
What are some complications that can arise during recovery? Surgery involves blood loss and shifts in fluids and salt levels in the blood that can have a number of negative effects. Pain management with narcotics also poses a problem. Narcotics may cause delirium, but so does uncontrolled pain -- so we have to strike a delicate balance in keeping the patient comfortable but lucid.
Then, complications can arise as a result of immobility. Chief among them is deep vein thrombosis, or blood clots in the legs. These can be life-threatening if a clot breaks off and travels to the lungs. Other potential problems include bleeding at the site of the fracture, infection from a surgical wound, urinary retention (especially for older men with prostate conditions), constipation, pneumonia, and urinary tract infections.
What steps are taken before surgery to ensure a successful recovery? Our motto is "From the ER to the OR." In other words, someone who has fractured a hip should go from the emergency room to the operating table as quickly as possible -- preferably within 24 to 48 hours. The longer a patient waits for hip surgery, the more likely he or she will develop complications from immobility, such as blood clots. People are unable to move because of the fractured hip, most don't want to eat, and it's common to become constipated and/or have trouble urinating.
How long does it take to recover from a hip fracture? We like to see a person out of bed on the first day after hip surgery and walking within one to three days. Inpatient rehabilitation takes approximately one week. After seven days, the expectation is that patients will be able to go home with an assistive device, such as a walker. Staples from hip surgery are removed as early as 10 days postsurgery. The hope is that in the weeks following hip surgery, patients will gradually transition to a less supportive device, such as a cane. Patients continue with physical therapy and outpatient rehab for about one month.
What should people do at home after a hip fracture? It's essential to follow the outpatient rehabilitation exercise plan. This consists of strength and balance training exercises that can be completed at home or on an outpatient basis at a rehabilitation facility. Building up strength is key to a successful recovery. A big problem is that many patients become less active at home because they are afraid of experiencing another fall and fracture.
Anxiety and depression are common, so patients see a psychologist at the rehabilitation center to help them overcome their fears. Patients are also urged to take vitamin D and calcium supplements to help strengthen bones. And, since a hip fracture is a de facto diagnosis of osteoporosis, patients should see their primary care physician for proper treatment.
Older adults with osteoporosis who have already fractured bones elsewhere in the body are at the highest risk for hip fracture, but everyone should be prepared -- men included. Men have a lower risk of osteoporosis, but they are also more likely to fare poorly after a fracture than women.
Posted in Osteoporosis on November 5, 2010
Reviewed September 2011
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