Hip Fractures and Treatment

With aging, the weakening of bones, along with problems related to balance and vision, increases the risk of hip fractures due to falls.

Hip fractures, which primarily affect the elderly population and represent a significant trauma, are serious injuries. The risk of hip fractures increases with age because the weakening of bones due to osteoporosis, combined with balance and vision problems in older adults, heightens the risk of falls leading to fractures. Anadolu Health Center Orthopedics and Traumatology Specialists Assoc. Dr. İbrahim Akmaz and Op. Dr. Mehmet Taner Özdemir emphasize that the treatment for hip fractures is almost always surgical. In this article, we share all the details on the topic based on the information provided by both of our specialists.

Most Common Age of Occurrence: Over 65 Years Old

The vast majority of hip fractures occur in individuals aged 65 and older. These fractures typically result from falls while walking, and it’s important to note that approximately 70% of the patients are women. But are there any cases among younger people? Yes, indeed; hip fractures in younger individuals account for one-tenth of all cases. These usually result from high-energy traumas, such as traffic accidents or sports injuries.

Initial Symptoms of a Hip Fracture

After a fall, patients with a hip fracture experience pain in the hip and groin area and are unable to walk. They cannot move their hips or find it very difficult to do so. Swelling and bruising may be observed on the fractured side, and the affected leg may appear shorter.

Treatment: Surgical

The treatment for a fractured hip is surgical. Generally, internal orthopedic implants (such as plates, screws, and nails) are used to stabilize the broken bones, or the fractured bone may be removed and replaced with a metal prosthesis.

Preparation for Surgery

Preparing elderly patients for surgery involves reviewing their existing chronic conditions, identifying the causes of falls, and ensuring optimal conditions (such as preparing for transfusions and assessing the need for intensive care). Surgical options are determined by examining various characteristics related to the patient and the fracture:

• The anatomical location of the hip fracture.
• The orthopedic technical classification of the fracture.
• The quality of the bone.
• The patient's condition (consideration should be given to the duration of surgery, expected blood loss, and existing health issues).

What Are the Risks?

There are risks that may negatively affect the treatment of patients during the surgical process. These include the formation of clots and embolisms (thrombus and emboli), bedsores, urinary tract and lung infections, nutritional and bowel problems, muscle weakness, and dependency. To reduce these risks, anticoagulant medications should be used, respiratory exercises should be performed, adequate fluid intake and a special nutrition program should be maintained, in-bed exercises should be conducted, and appropriate patient care should be provided.

Post-operative rehabilitation of the patient is a crucial process that should be monitored, aiming for the patient to regain walking ability, achieve self-sufficiency, and eliminate the factors leading to the fracture. Rehabilitation should begin immediately after surgery and continue at home following discharge. Through a dynamic and functional training program, the patient should be made self-sufficient and assisted in returning to the independent lifestyle they had prior to the fracture.

Risk Factors for Hip Fractures in the Elderly

• Osteoporosis
• Gender (Most cases are women)
• Lack of sports and exercise
• Tobacco and coffee consumption
• Insufficient intake of protein, calcium, and vitamin D through diet
• Use of certain medications: Corticosteroids that reduce bone density, sleeping pills used for neurological disorders, antidepressants, and epilepsy medications can affect balance and coordination, increasing the risk of falls
• Some diseases (Intestinal diseases affecting calcium and vitamin D absorption, thyroid disorders that can lead to bone weakness, dementia, and Parkinson's disease that cause balance and coordination problems)

8 Important Points for Prevention!

Building a healthy lifestyle is essential for preventing hip fractures. This involves implementing the following recommendations:

1. Adequate nutrition: Ensure intake of protein, calcium, and vitamin D.
   • For those over 50, consult a physician to take 1200 mg of calcium and 600 IU of vitamin D daily.
2. Exercise: Walking increases overall muscle strength, maintains balance, and strengthens bones.
3. Reduce tobacco and excessive coffee consumption: Minimize or quit if possible.
4. Home hazards: Secure electrical cords along walls, and take necessary precautions for slippery surfaces (bathroom-toilet). Arrange furniture and items to provide a straightforward path in every room (especially to the toilet) and eliminate trip hazards.
5. Eye examinations: Keep up with annual check-ups.
6. Management of existing internal diseases: Do not neglect the follow-up of conditions like diabetes, hypertension, and dementia, as well as the management of medications.
7. Stand up slowly: Sudden movements can lead to drops in blood pressure and balance problems.
8. Use of a cane or crutches: They should be used as a precaution against falls in individuals with balance and vision issues.

Nearly half of elderly patients who experience a hip fracture cannot return to their previous independent and unassisted lifestyle before surgery. Therefore, it is crucial to take necessary precautions, especially to avoid falls.