Overcoming Hip Fractures

“Mom has fallen and broken her hip.”

Adult children fear hearing those words as their parents age.

Each year, more than 300,000 Americans age 65 and older are hospitalized for hip fractures, according to the Centers for Disease Control and Prevention (CDC). More than 75 percent are women. More than 95 percent of hip fractures are caused by a fall.

“When a patient falls and breaks their hip, it’s hard on the whole family,” says Marc Wahlquist, MD, an orthopedic surgeon with the TriHealth Orthopedic & Sports Institute.“ Most of these patients are medically fragile. If they aren’t dealt with in a timely, evidence-based manner, it can be a downward spiral.”

Dr. Wahlquist says studies show that getting people into surgery faster and getting them up and moving within hours of surgery are restoring mobility better and faster.

As little as a decade ago, he says patients with a fractured hip often waited days before having surgery. “That’s no longer acceptable,” he says. “At TriHealth, we have a goal of getting patients to surgery within 24 hours of their arrival in the Emergency Department.”

Equally important is getting patients up on their feet within four hours of surgery. “If you let people sit, they’re at risk for complications like blood clots, bed sores and pneumonia,” Dr. Wahlquist says.

Surgical Fix

The surgery required depends on where the fracture occurs on the thigh bone. The two most common hip fractures are:

• Femoral neck fracture, a break in the thigh bone at the neck that’s just below the “ball” that fits into the hip socket. Surgical options are to use screws to hold together the head and neck of the femur or to do a partial or full hip replacement. Dr. Wahlquist says the latter is often more reliable and gets a person up and moving faster.
• Intertrochanteric fracture, a break between the bony protrusions called trochanters, near the top of the thigh bone. To repair this fracture, the surgeon places a rod in the middle of the bone, using a large screw going into the head of the femur. The bone heals around the rod, and the person can bear weight right away.

Team Approach

Dr. Wahlquist says surgical technique has improved, but he believes the most important advances have been in the processes before and after surgery.

“We have a standardized, complex pathway from the time the patient comes through the door of the ED and throughout their hospital stay,” Dr. Wahlquist says. “There are lots of parts, and everyone has their role to play.” He notes that physicians, nurses, pharmacists, advanced practice nurses, and others contribute to making a patient’s care plan smooth and efficient.

Because of its excellent care coordination and outstanding results, Bethesda North Hospital is recognized as an Orthopedic Center of Excellence, and has received the Gold Seal from The Joint Commission for Hip Fracture certification. The hospital also has certification from NICHE (Nurses Improving Care for Healthsystem Elders), demonstrating its sensitive and exemplary care for patients age 65 years and older.

Dr. Wahlquist tells his patients, “My goal is to get you back to your baseline level of function—back to walking, using a cane or doing whatever you were doing before.”

Preventing Falls

Dr. Wahlquist offers these tips to prevent falls that often lead to hip fractures:

• Clear clutter from your floors: phone cords, electrical cords, throw rugs.
• Place non-slip mats and grab bars in your bathroom.
• Put hand rails on all stairs.
• Keep your home well-lit, using night lights at night.
• Do exercises such as walking, light weights and yoga to help with strength, endurance and balance.
• Take calcium and vitamin D supplements as needed to strengthen bones.
• Use assistive devices as needed, such as canes or walkers.
• For high-risk patients, wear hip pads to cushion a fall.