Hip fracture

Treatment and care

Most patients with a hip fracture require surgery. The orthopaedic team in charge of your care will discuss the most appropriate treatment with you and the risks involved. The operation will normally be carried out within 36 hours of your admission to the ward.

The operation that you have will depend on the type of hip fracture you have. You may receive:

• a sliding hip screw (screw and plate)
• a half hip replacement (hemi/bipolar - arthroplasty)
• a total hip replacement
• a nail
• cannulated screws

Care of the elderly - physician input

A medical doctor visits the orthopaedic ward each weekday. The aim is to provide you with specialist medical support and advice following your hip fracture. The doctor will review and may adjust your regular medications both before and after your operation.

Pain relief

You will still have pain in your hip after your operation. While on the ward you will be given strong pain killers at regular times, and you can request additional pain killers. Good pain relief is helpful as it will help you to walk sooner and may lead to a shorter stay in hospital.

Recovery

Early mobilisation

You will be assisted out of bed as soon as possible after your operation, usually the following day. Your physiotherapist or nurse will assist you and assess the most appropriate walking aid. This may be a walking frame or mechanical hoist. You may progress to sticks or elbow crutches.

Early mobilisation helps prevent complications such as chest infection, skin problems and clots in the lower legs. It also helps with the pain, which sounds counter intuitive!

See Leaving hospital and Get up, get dressed, get moving with The Broons.

Discharge

During your hospital stay, healthcare staff will discuss your home and social circumstances with you, and if appropriate, talk with your family or carer. We start planning your discharge back home when you arrive onto the ward, and the following criteria need to be fulfilled for you to return home:

• you must be medically stable
• your hip wound must be clean and dry
• your physiotherapist and occupational therapist have assessed that you are ready for discharge

Exercises after a hip fracture

See Advice Following Hip Fracture - An Information Guide for Patients and Carers (pdf - review date January 2025) from NHS Eileanan Siar (Western Isles).

How can my family and carers help?

Your family and carers can help assist with your recovery while you are in hospital and when you are home.

• Bring in any walking aids, spectacles or hearing aids.
• Bring in loose-fitting clothing and footwear for you to wear. We encourage you to wear your own clothes once you have had your operation.
• Share any information with staff about previous falls they know of.
• Place the nurse call-bell near to you when they leave.
• Put the chair away when they leave and avoid moving furniture or leaving things like bags lying about.
• Inform nursing staff if they have any concerns about you or your safety.
• Be proactive in discharge planning discussions.
• Complete a This is me document if required - a simple leaflet for anyone receiving professional care. See This is me at the Alzheimer's Society website.

Risks

Wound information

During your operation you will be given antibiotics to reduce the risk of developing a wound infection. While in hospital your wound dressing will also be checked regularly. This dressing can be left in place for 7-10 days and the type of dressing and wound closure used will be discussed with you. The dressing will be removed by a healthcare professional if you are in hospital during this period, or you will be given instructions on removing the dressing if you return home before the 7-10 days.

After the operation you can expect bruising, which may be extensive around the operation site.

Once you leave hospital you should contact the hip fracture nurses if you experience:

• a red hot wound
• you feel generally unwell
• your wound starts to leak

Delirium

It is possible that after a hip fracture you may experience a delirium. A delirium is a state of confusion that can occur due to the injury or subsequent operation. Delirium takes time to settle and can last for weeks or months. The confusion can fluctuate in severity. It is important that you drink plenty of water, that your bowels are moving and that you are out of bed during the day, if well enough.

See an information leaflet about delirium from Health Improvement Scotland (pdf, March 2019).

Deep Venous Thrombosis (DVT) clot

This may occur as a result of your hip fracture and the reduction in your mobility. You will be prescribed medication which can help reduce the risk of this developing. Getting out of bed, early mobilisation and continuing your exercises will reduce this risk.

If you develop pain, tenderness, or heat in the calf muscle, please contact the hip fracture nurses or your GP.

Pulmonary embolus

An undiagnosed blood clot could break away from the vein and travel to the lungs. This is an emergency, and you should call 999 if a blood clot is suspected:

• sudden chest pain
• difficulty with breathing or rapid breathing
• shortness of breath
• sweating
• confusion