F - Wk9 Hip Fractures

Question 1

What are hip fractures?

Answer 1

• occur in the upper third of the thigh bone = femur

Question 2

What are the types of hip fractures?

Answer 2

1. intracapsular fractures
   - fractures that happen within the capsule of the hip joint
   - most common sites for a hip fracture is at the femoral neck
2. extracapsular fractures
   - fractures that happen outside the capsule

Question 3

What are the causes of intracapsular and extracapsular fractures?

Answer 3

Intra:
- trauma and osteoporosis
- Low bone mass due to osteoporosis makes the bones more fragile -> high risk of breaking
- called fragility fractures -> usually occur after minimal trauma like falling from a chair

Extracapsular:
- severe direct trauma, like a car crash

Question 4

Risk factors for hip fractures?

Answer 4

1. old age, which can lead to falls
2. female
3. family history of osteoporosis

Question 5

Complications of hip fractures?

Answer 5

1. avascular necrosis of the femoral head
   - main blood supply for the femoral head comes from the lateral femoral circumflex artery that travels along the femoral head
   - often compromised during a hip fracture
2. reduced blood flow = slower healing
   - longer periods of immobility & hospitalisation
   - increases risk of developing thrombotic complications, like DVT, pulmonary emboli & infections

Question 6

What are the signs & symptoms of hip fractures?

Answer 6

1. severe pain and tenderness around the affected area
   - makes it difficult to bear weight on the affected leg
2. Sometimes: abduction & external rotation of the hip joint, muscle spasm, & shortening of the affected limb

Question 7

Whats the treatment for hip fractures? (idt this is impt)

Answer 7

1. Acute management
   - control pain using a regional nerve block + immobilise hip joint.
   - Buck’s traction: keeps leg in an extended position,
   - surgical repair + stabilise the displaced bones
   - Anticoagulants:to prevent thrombosis and avascular necrosis
2. rehabilitation
   - Physical therapy: early, frequent exercises that restore strength & tone hip muscles
   - occupational therapy: help with ADLs

Question 8

What is the nursing management you’ll provide for your patient?

Answer 8

1. Prepare your patient for surgery
   - immobilise affected limb & help them into a comfortable position
2. After surgery:
   - monitor for complications related to the procedure
   - put them on fall precautions, bed rest & immobilise the affected limb
   - ensure that head of the bed is not elevated > 45 degrees to prevent excessive hip flexion
3. if your patient is old, r they are at increased risk of delirium during hospitalisation

Signs of delirium:
- decreased ability to focus & disorientation
- disturbances in understanding of language
- compare current mental status with their baseline

4. Regularly perform a full neurovascular assessment
5. administer prescribed venous thromboembolism prophylaxis
   - monitor for signs of DVT or pulmonary embolism
6. early mobilization can prevent postoperative complications and speed your patient’s recovery
   - During therapy sessions: protect their operative site by not flexing their hip > 90 degrees while sitting
   - or crossing their surgical leg across their body’s midline

Question 9

What is the client & family teaching you’ll provide for your patient?

Answer 9

Review how to keep their hip in proper alignment

DONT:
- cross their legs or ankles when sitting or lying down
- bending at their hips > 90 degrees
- lift their knee higher than their hip

DO:
- keep their knees and toes pointed forward when they sit, walk, or stand
- keep a pillow between their knees when they’re in bed -> prevent their surgical leg from crossing over the midline of their body
- using a raised toilet seat extender can avoid excessive bending at the hip when using the bathroom
- ensure they know how to use adaptive devices to support their independence, like a sock aid.