Recovering from a hip fracture following an accident

Transcription

1 South Tyneside NHS Foundation Trust Recovering from a hip fracture following an accident Providing a range of NHS services in Gateshead, South Tyneside and Sunderland.

2 What is a hip fracture? The hip joint is described as a ball and socket joint, because the top end of the femur is shaped like a ball which fits into the pelvis. A hip fracture or broken hip bone occurs under the ball of the femur. Most hip fractures require an operation before it is possible to walk. Rarely, a hip fracture may be treated without an operation but your doctor will fully discuss this with you. There are two main types of hip fracture that occur at different parts of the femur and require different types of operations. 2

3 Subcapital Fracture: This fracture happens below the femoral head (the ball) and can damage the blood supply which will result in the bone not healing. The operation to repair the injury involves removing the head and neck of the femur and replacing it with a metal ball and stem which fits into the top end of the bone. The stem goes down the centre of the femur. This is called a Hemiarthroplasty, sometimes called half a hip replacement 3

4 Intertrochanteric fracture: This fracture happens further down the femur This operation involves fixing a metal plate to the side of the femur with screws and putting a long screw across the fracture into the top of the femur. This is called a Dynamic Hip Screw or DHS for short. There are other operations that can be carried out for these fractures but these are the most common Before you have your operation, the surgeon will explain your fracture type and what operation is recommended. All types of surgery carry risks and your doctor will discuss these with you. 4

5 Before your operation You will have had x-rays and blood tests taken on arrival to emergency care. Pain relief will also be given. You may also have been given an injection into your hip to numb the pain and had a drip put into your arm so you can be given fluids and medication. When you arrive on the ward: We understand that this injury can be very painful and it is important that we regularly check your pain. The ward staff will ask you to score your pain, and give you medication to help manage your pain. We will give you compression stockings which you will have to wear for six weeks We will give you injections under your skin once a day to prevent blood clots. You will get these for 28 days in total. Your surgeon and anaesthetist will come and see you to make sure you understand the operation so you can give your consent. The anaesthetist will discuss with you the best anaesthetic for you Your operation site will be marked with a pen We will give you some ointment to put into your nose to prevent infection We will not normally pass a tube into the bladder unless you cannot pass urine or it is too painful to use a bedpan. We will do our best to avoid this as there is an increased risk of infection, but we will prescribe you antibiotics if necessary. The operation will normally take place within 36 hours of your admission unless you need further treatment or investigations prior to the operation. We will explain to you if there is a delay in your operation and why. 5

6 Your Anaesthetic There are two main types of anaesthetic used: A general anaesthetic so you become unconscious and feel nothing. A spinal anaesthetic which is an injection of local anaesthetic into your lower back making you numb from the waist downwards. Some people remain awake during the operation but, if you wish, you can have medicines that make you very sleepy and relaxed. Your anaesthetist will talk to you about the form of anaesthetic which is best for you and your condition. Your anaesthetist is a doctor with specialist training who will visit you on the ward. They will agree a plan with you for your anaesthetic and pain control afterwards. They will also have to decide whether you can have your operation straight away. Occasionally they may discover medical problems that need to be treated before you can safely be anaesthetised. This might be a very fast heart rate, or needing blood thinning medicines to be reversed. As hip fractures need to be treated as soon as possible, the anaesthetist who sees you on the ward may be different to the one who gives you the anaesthetic, but all the information is carefully noted and passed on. 6

7 After your operation Recovery Room: You will be taken to the recovery room before returning to the ward. You will be attached to machines to monitor your heart rate You will have a probe put onto one of your fingers to check your oxygen levels You may have an oxygen mask over your nose and mouth You will have special cuffs around your legs that inflate alternately. They help in the prevention of blood clots. These will continue on the ward until you are able to get out of bed When you are comfortable and your observations are satisfactory, you will be taken back to the ward on your bed On return to the ward: We will sit you up in bed as soon as possible to prevent any problems with your chest Your leg should start to feel a little more comfortable, but the nurses will check your pain levels regularly and give you pain relief when you need it You may have an oxygen mask over your nose and mouth to help with your breathing You will have blood tests the day following the operation and you may also need an x-ray of your hip If the results of the blood tests show that you are anaemic, you may need a blood transfusion but we will discuss this with you in detail 7

8 If you have had a tube put into your bladder, we will remove it as soon as possible to reduce the risk of infection and make you more comfortable Constipation is very common because you are not moving about much, have had a change in diet, and some pain medication can cause it, but we can give you laxatives to help. You should also try to drink plenty of fluids. Your wound site will have a dressing over it. Staff will look at the wound only when it is necessary. If there are metal clips or stitches in the wound, the orthopaedic outreach team will take these out 14 days after your operation when you have been discharged. We will provide you with a high protein diet and dietary supplements if necessary to help with your healing process We will give you daily blood thinning injections to avoid clots You can shower almost immediately as the wound dressings are waterproof, but you should not have a bath for least three months. Your expected length of stay in hospital should be approximately 10 days. 8

9 Getting back on your feet: Normally, you start getting out of bed the next day after your operation with the help of the physiotherapists and nurses. Unless your surgeon instructs otherwise, you will begin walking the next day usually starting with a frame and progressing onto crutches. You will be encouraged to walk whenever possible. We encourage you to wear your own loose fitting clothes and supportive footwear. Orthogeriatricians You will be visited regularly by a team of medical doctors, who do not perform operations but aim to support you as you recover from your surgery. They are falls specialists so if your fracture happened because you fell, they will carry out an assessment to find out the cause and may need to refer you to the falls clinic for further investigation. They will also assess you for a condition called osteoporosis (thin bones). It is very common in patients with a hip fracture, and almost always occurs in patients aged 75 years and older. If you are in this age group we will often recommend you start treatment which is usually taking a calcium tablet and a specific osteoporosis tablet. If you are younger than 75 years, we will refer you for a scan as an outpatient and send the results to your GP. If osteoporosis is confirmed, your GP will start your treatment with you. 9

10 Rehabilitation Everyone gets better at different rates. The nurses and physiotherapists will help you to get moving and carry out exercises. The occupational therapists will see how well you can get into and out of bed and also check how well you can wash and dress yourself. If you need any equipment for home, such as bathing aids or a raised toilet seat, staff will order these for you so that they are delivered to your home before you are discharged. The occupational therapist may visit your home with a relative present to assess your home environment to see what equipment you may need. A social worker will talk to you about going home and will arrange help for you if you need it. If you need a longer period of rehabilitation the ward staff will arrange for you to be transferred to another department to stay before you go home. The compression stockings need to worn when you are discharged at home for six weeks. They are very difficult to put on and you may need someone to help you. You will only be issued with one pair of stockings. They can be removed during the day so they can be washed, but they must be ready again to wear through the night. 10

11 The Orthopaedic Outreach Team (O.O.T.) The OOT in South Tyneside can provide you with rehabilitation and wound care in your own home. The team consists of an orthopaedic nurse and two therapy assistants. Most people who have a hip fracture can benefit from visits by the team, unless there are any conditions which may make rehabilitation unfeasible. When the doctors and therapists think you are ready for home, you will be seen by a member of the team and be given appointments for home visits. There are many benefits of accessing this service, including having a smoother transition from hospital to home, somebody you can call 24 hours a day if you have any worries and rapid access to further equipment requirements. We can visit you at home for up to six weeks after your discharge home. If you have on going rehabilitation needs after that, you may be referred to a longer term rehabilitation team. 11

12 Contact details: Orthopaedic Trauma Nurse Co-ordinator South Tyneside District Hospital Harton Lane South Shields Tyne and Wear NE34 0PL Tel: There is an answer machine available for you to leave a message if the Orthopaedic Trauma Nurse Co-ordinator is not available. Alternatively you can contact Ward 7 on Orthopaedic Outreach Team South Tyneside District Hospital Harton Lane South Shields Tyne & Wear NE34 0PL Tel: Or you can use the mobile numbers in the OOT leaflet you received on discharge. Alternatively you can contact ward 7 on We are committed to raising the standard of written information for patients, their carers, people who use the NHS and the general public. This information can be made available in another format or language on request. For further copies of this leaflet please contact on telephone numbers above. Production date: February 2017 Author: Orthopaedic Trauma Nurse Co-ordinator Code: 0217/470 Review date: February 2020