1. CONCEPT MOBILITY
HIP FRACTURES

2. HIP FRACTURE OBJECTIVES
Explain the exemplar hip fractures (including definition, antecedents, and attributes).
Analyze conditions which place a patient at risk for hip fractures.
Recognize the negative and positive consequences of hip fractures.
Discuss the interrelated concepts that work together to ensure positive outcomes related to hip fractures.

3. HIP FRACTURE OBJECTIVES
Discuss the interrelated concepts that if depleted or impaired can cause a negative consequence in ensuring positive outcomes of hip fractures.
Apply the nursing process (including collaborative interventions) for individuals experiencing a hip fracture and promote normal healing.

4. HIP FRACTURE Common among older adults 90% due to fall
320,000 hospital admission annually
By age 90 approximately 33% of all women and 17% of men
30% will die within 1 year of injury
Hip fracture occurs more frequently in women because of osteoporosis.
Will die within 1 year of injury due to medical complications caused by the fracture or resulting in immobility.
Many older adults with hip fracture will also develop disabilities needing long term care.

5. HIP FRACTURE DEFINED Fracture of the proximal third of the femur
Intracapsular fracture- fractures that occur within the hip joint capsule (femoral neck)
These fractures are often associated with osteoporosis and minor trauma
1. Capital – fracture of the head of the femur
2. Subcapital – fracture just below the head of the femur.
3. Transcervical – fracture of the neck of the femur.
Extracapsular fracture- occur outside the joint capsule
These fractures are usually caused by severe direct trauma or a fall

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FRACTURE OF HIP
Fig Femur with location of various types of fracture. 6
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7. RISK FACTORS Complete mobility and strength to immobility
Chronic health problems
65 years of age and older, more frequent
Environmental hazards
Women due to osteoporosis
Post menopausal women
Trauma
Multiple medication usage

8. CLINICAL MANIFESTATIONS
External rotation
Muscle spasm
Shortening of extremity
Severe pain
Radiograph (X-ray) 8
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9. COLLABORATIVE CARE Open reduction Closed reduction Surgical repair
Buck’s traction
Open reduction
Correction of bone alignment through surgical incision
Includes internal fixation with use of wires, screws, pins, plates, intramedullary rods, or nails
Closed reduction
Nonsurgical, manual realignment of bone fragments to previous anatomic position
Traction and countertraction manually applied to bone fragments to restore position, length, and alignment

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FRACTURE OF HIP
Fig Types of internal fixation for a hip fracture. A, Femoral head endoprosthesis.
B, Type of hip compression screw with side plate. 10
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BUCK’S TRACTION
Buck’s traction is most commonly used for fractures of the hip and femur.
Fig Buck’s traction. Most commonly used for fractures of the hip and femur.
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FRACTURES
Fig Buck’s traction. Most commonly used for fractures of the hip and femur. 12
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13. NURSING MANAGEMENT NURSING ASSESSMENT
Objective Data
Complete physical and focused assessment
Deformity or unnatural position of affected limb
Edema and ecchymoses
Muscle spasm
Tenderness and pain
Loss of function
Numbness, tingling, loss of distal pulses
Pallor and cool skin or bluish and warm distal to injury
Ecchymosis
Hematoma
↓ or absent pulse distal to injury
↓ skin temperature
Delayed capillary refill
Paresthesias
↓ or absent sensation
Hypersensation
Muscle weakness
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14. NURSING MANAGEMENT NURSING ASSESSMENT
Subjective data
Past health history
Traumatic injury
Bone or systemic disease
Prolonged immobility
Osteopenia
Osteoporosis
Medications
Use of corticosteroids (osteoporotic fracture)
Analgesics
Surgery or other treatments
Previous musculoskeletal surgeries

15. NURSING MANAGEMENT NURSING ASSESSMENT
Subjective data
Health perception–health management
Estrogen replacement therapy
Calcium supplements
Activity-exercise
Loss of motion or weakness
Muscle spasms
Cognitive-perceptual
Sudden and severe pain in affected areas
Numbness, tingling, loss of sensation

16. NURSING MANAGEMENT NURSING ASSESSMENT
Neurovascular assessment:
Peripheral vascular assessment
Color
Temperature
Capillary refill
Peripheral pulses
Edema
Peripheral neurologic assessment
Sensation
Motor function
Pain

17. NURSING MANAGEMENT NURSING DIAGNOSIS
Acute Pain
Risk for Peripheral Neurovascular Dysfunction
Risk for Infection
Impaired Physical Mobility
Disturbed Sensory Perception: Tactile
Ineffective Self-Health Management
ND related to Postoperative Surgical Procedure

18. NURSING MANAGEMENT PLANNING
Overall goals
Have physiologic healing with no associated complications
Achieve maximal rehabilitation potential
Obtain pain relief adequate to allow for rest and comfort
Experience no complications as a result of fracture or treatment
Experience no ongoing loss of function as a result of fracture
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19. NURSING MANAGEMENT INTERVENTIONS
Closed Reduction
Buck’s Traction – immobilization and manage muscle spasms
Maximum of 24 to 48 hours
inspect exposed skin regularly
assess bony prominences
maintain appropriate extremity alignment
NV assessment
monitor and maintain weights
External rotation of hip can occur when skin traction is used on lower extremities.
Nurse can correct this position by placing a pillow, sandbag, or rolled-up draw sheet along greater trochanteric region of the femur
NV assessment is frequent every hour or every 2 hours.
Bucks traction used for a maxiumum of 24 to 48 hours

20. NURSING MANAGEMENT INTERVENTIONS
Open Reduction and Internal Fixation
Surgical repair
Early immobilization
Decreases risk of major complications
Includes internal fixation with use of wires, screws, pins, plates, intramedullary rods, or nails
Surgical repair is the preferred method of managing intracapsular and extracapsular hip fractors.
Disadvantages: post surgical complications, anesthesia

21. NURSING MANAGEMENT INTERVENTIONS
Preoperative Care:
Pain control
Traction
Analgesics
Muscle relaxants
Comfortable positioning
Safety measures
Neurovascular assessment
Teaching
Exercising unaffected leg and arms
Overhead trapeze bar
Post operative surgical ex: TCDB, infection control, DVT prevention

22. NURSING MANAGEMENT INTERVENTIONS
Post operative Care:
Monitor VS and Neurovascular assessment
I &O
Respiratory activities ex: TCBD and Incentive Spirometry
Pain control
Analgesics
Muscle relaxants
Comfortable positioning/alignment
Safety measures
Elevate extremity
Incision Care
Constipation
Use of abductor splint or pillow between the knees when turning from side to side for alignment

23. Explain collaborative care of hip fracture.

24. Patient and Caregiver Teaching
Prevent prosthesis dislocation
Large pillow between legs when turning
Avoid extreme hip flexion
Avoid turning onto affected side

25. NURSING MANAGEMENT NURSING IMPLEMENTATION
Health promotion
Public should be taught to take appropriate safety precautions.
Nurses should advocate for personal actions to decrease injuries.
Encourage moderate exercise to keep muscles strong and maintain balance.
Calcium and vitamin D intake
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26. NURSING MANAGEMENT AMBULATORY AND HOME CARE
Psychosocial problems
Short-term rehabilitative goals
Transition from dependence to independence in performing simple activities of daily living
Preserve or ↑ strength and endurance
Long-term rehabilitative goals
Prevent problems associated with musculoskeletal injury
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