Introduction
Hip fractures are a major health concern for the elderly, with the risk increasing dramatically with age. They are more common in individuals over 65, and the incidence is particularly high in those over 85. This is often due to the increased likelihood of falls and decreased bone density associated with ageing.
Hip fractures can significantly impair mobility and independence, and can lead to serious health complications for the elderly.
In this article, we’ll be covering the different types of treatment and several aspects of post-treatment recovery to consider before proceeding with surgery for a hip fracture.
What Are Hip Fractures?
Hip fractures refer to breaks in the upper part of the femur, or the thigh bone. This region includes the femoral head (the ball that fits into the socket in your hip), the femoral neck, and the trochanteric region, which is slightly lower.
The femoral neck is a narrow area just below the ball of the hip joint. Fractures at this site are more common in the elderly, particularly those with weakened bones from osteoporosis.
Risk Factors for Hip Fractures In The Elderly
Hip fractures in the elderly are often the result of a combination of age-related changes and environmental risks. Below are some key factors:
Ageing: With age, bones tend to lose their density and become more brittle, increasing the risk of fractures. Muscle mass and strength also decline, potentially affecting balance and mobility.
Gender: Women are more susceptible to hip fractures due to a higher risk of osteoporosis, especially after menopause.
Chronic Medical Conditions: Diseases such as osteoporosis, arthritis, dementia, Parkinson’s disease, and stroke can contribute to the risk of hip fractures.
Medications: Some drugs can lead to bone weakening, dizziness, or confusion, increasing the likelihood of falls and fractures.
Lifestyle Factors: Poor nutrition, physical inactivity, alcohol abuse, and smoking can weaken bones and affect balance.
Environmental Hazards: Falls are a leading cause of hip fractures. Slippery surfaces, poor lighting, loose rugs, and clutter can increase the risk of falls.
Surgical Treatment Options
When a hip fracture occurs in an elderly individual, surgical intervention is often the most effective treatment route.
Dr LS Wang is a internationally recognised Hip specialist and has a keen interest in treating hip fractures with the latest minimally invasive methods. His philosophy is for enhanced recovery with early weight bearing and return to function. He employs the latest methods and techniques to fix or replace hip fractures and is highly sought after to teach surgeons in these techniques.
Internal Fixation (Hip Preserving)
This surgical technique is often used when the fracture is not displaced, meaning the bones can still align correctly. Internal fixation involves the use of metal screws, nails, or plates to hold the broken pieces of the femur in place while the bone heals. The hardware is inserted during a surgical procedure, under anaesthesia.
Internal fixation is utilised for non displaced neck of femur fractures or for extra-capsular proximal femur fractures such as fractures around the inter-trochanteric region.
The main aim of this approach is to preserve the patient’s own hip joint. The success of internal fixation largely depends on the bone’s ability to heal, which can be impaired in elderly individuals with conditions like osteoporosis that weaken the bone structure.
Partial Hip Replacement (Hemiarthroplasty)
A partial hip replacement is typically recommended when the fracture occurs in the femoral neck and the bones are displaced, or when the blood supply to the broken bone pieces is compromised.
This is a very effective procedure which allows immediate weight bearing.
In this procedure, the surgeon replaces the femoral head and neck — the ‘ball’ part of the ball-and-socket hip joint — with a metal prosthesis. The socket part remains natural. This procedure can relieve pain and improve function in the hip.
Total Hip Replacement (Arthroplasty)
In a total hip replacement procedure, both the ‘ball’ (the femoral head and neck) and the ‘socket’ (the part of the pelvic bone into which the femur fits) are replaced with prosthetic components.
This option is generally considered when the patient has additional hip joint issues, such as arthritis, that are causing pain and impairing function. A total hip replacement can offer excellent pain relief and restore a good range of movement.
This is a very effective procedure which allows immediate weight bearing.
Not sure which procedure is suited for your condition? Consult our hip specialist for an accurate diagnosis and personalised treatment plan.
Factors Influencing Treatment Choice
The choice of treatment depends on several factors, including the patient’s general health, the type of fracture, and the patient’s lifestyle and needs. For instance, surgery may not be recommended for someone with severe health issues, while a very active elderly individual may benefit more from a total hip replacement.
Consult our hip specialist today for an accurate diagnosis of your condition and a personalised treatment plan.
Recovery and Rehabilitation for the Elderly
Recovery and rehabilitation following hip fracture treatment are typically a complex process, requiring the coordinated effort of a multidisciplinary team. This process focuses on pain management, promoting mobility, preventing complications, and gradually regaining strength and independence.
Post-Surgery Care
The initial stage of recovery begins right after surgery. The medical team places a high priority on managing pain to ensure patient comfort, using a combination of medications that are closely monitored for effectiveness and potential side effects.
The prevention of blood clots, a common complication post-surgery, is another aspect of post-operative care. This may involve the use of blood-thinning medications or mechanical interventions, such as compression stockings or devices that encourage leg movement.
Encouraging early mobility is also a key focus. Despite the potential challenges, getting the patient to move as soon as it’s safe can prevent a host of complications.
These include bedsores, arising from prolonged immobility, and pneumonia, a potential risk due to decreased lung activity.
Rehabilitation Programme
Once the initial post-operative phase has passed, the patient moves into a more active stage of recovery, involving a combination of physical and occupational therapy.
Physical Therapy
A specially designed physical therapy programme can aid in a patient’s recovery. This programme involves exercises tailored to the patient’s needs and capabilities, aiming to restore strength, improve balance, and enhance overall mobility. The pace of progress is closely monitored, and the exercises are adjusted accordingly, providing a progressively challenging regimen that promotes continual improvement.
Patients may also be advised on using mobility aids, such as walkers or canes, which can provide additional support and stability during the recovery period.
Occupational Therapy
Alongside physical therapy, occupational therapists help patients regain their capacity to perform daily activities. This includes tasks like dressing, bathing, and managing kitchen duties. The therapist may introduce aids and techniques to simplify these tasks, making them less physically demanding and reducing the risk of falls or injuries.
Home Adjustments
As the patient prepares to return home, certain modifications may need to be made to ensure a safe and comfortable environment. These could include removing potential tripping hazards, such as loose rugs or clutter, installing handrails in critical areas like bathrooms and stairways, and adding aids like raised toilet seats or shower chairs to facilitate daily activities.
These changes can improve the patient’s mobility and independence, promoting a faster and smoother recovery.
Role of Caregivers in Recovery
Throughout the recovery and rehabilitation process, caregivers can play a vital role as well. A caregiver’s tasks extend beyond assisting with daily chores or physical exercises, offering emotional support and encouragement.
Being there for the patient, offering reassurance, celebrating progress, and maintaining a positive outlook can have a profound effect on the patient’s motivation and mental well-being.
Prevention of Hip Fractures in the Elderly
Nutrition and Exercise
A balanced diet rich in calcium and vitamin D, along with weight-bearing exercises like walking, can help maintain bone health and reduce the risk of fractures.
Fall Prevention Strategies
These include wearing non-slip shoes, keeping the home well-lit, removing hazards, and using assistive devices if needed.
Regular Medical Check-ups
Regular check-ups can help detect and manage health conditions that increase the risk of falls and fractures.
Role of Medication in Bone Health
Certain medications like bisphosphonates can help improve bone density and prevent fractures in people with osteoporosis.
Conclusion
Hip fractures in the elderly are a significant health concern but can be effectively managed with prompt treatment and comprehensive rehabilitation. Prevention strategies can reduce the risk of fractures and ensure a better quality of life for the elderly. With appropriate care and resources, it’s possible for elderly individuals in Singapore to recover from hip fractures and lead fulfilling, active lives.
