Hip Fracture: A guide for patients and relatives

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The National Hip Fracture Database

What is the National Hip Fracture Database?
A hip fracture is a common injury, and caring for patients with a hip fracture is an important part of the work of the NHS. This hospital takes part in the National Hip Fracture Database (NHFD),
which has been set up to improve the care of patients who have broken a hip. Information gathered about care in hospital and about recovery afterwards enables us to measure the quality of that care and helps us to improve the services we provide.

Reports based on NHFD data are made to our clinical staff to assist them in improving care here. The NHFD national reports show how different hospitals compare, thus helping to improve standards of care nationally. So, information about your care and progress is important, and will be collected during your hospital stay. And, because your progress after you leave hospital matters to us, you may be contacted later about how you are getting on.

All information collected is confidential, and no information is ever made public about you or about any other patient. All NHFD information is stored, transferred and analysed securely – both in this hospital and within the national database – in keeping with the provisions of the Data Protection Act (1998). Participation is, of course, voluntary; and you are free, if you so wish, not to take part – tell your doctor if you do not wish to participate. However, the more people take part, the more helpful NHFD will be in improving care.

NHFD is supported by the National Clinical Audit Support Programme, a division of the Information Centre for Health and Social Care.

What is a hip fracture? ………………………..3
Members of the MDT team…………………….6
On the day of surgery………………………….

What is a hip fracture?

A hip fracture is another term for a broken hip. It is a very common injury, which affects mainly older people. Around 65,000 hip fractures are treated each year in the UK, and is one of the most
frequent reasons for being admitted to an Orthopaedic ward.

Your hip is a ball and socket joint, where the ball (head) of the femur fits into the socket (acetabulum) of the pelvis.

The location of your hip fracture and any underlying medical conditions you have, will determine the treatment your Orthopaedic Consultant will offer you.

In some cases it may be best to treat the hip fracture without an operation i.e. the fracture is stable and unlikely to move when you walk. This is a serious injury, although the outcome for most patients is good, the fracture alone is associated with causing high rates of illness and in the frail and elderly possibly even death within the first month (with or without surgery). The estimated
risk of death for patients having an emergency operation for a hip fracture is that 10% (1 in 10) die within 1 month. An individual persons outcome will depend on how fit they are prior to the injury.

The aim of surgery is to get you back on your feet and home as soon as possible. We anticipate a stay of 10-14 days, however some people recover quicker and others require a little more time. The aim is for you to return to your home with appropriate assistance should you need it.

Members of the multidisciplinary team

The people you should expect to meet during your stay.

• Orthopaedic Doctors
• Care of the Elderly Doctor
• Anaesthetist
• Nursing Team
• Physiotherapy team
• Occupational Therapy Team
• Discharge team

What to expect…

On the day of surgery
• You will be added to the trauma operating list and other emergencies will determine when your operation is. You will be informed on the morning of your surgery and be kept updated if anything changes.
• You should be “nil by mouth” 6 hours prior to surgery. You may be given a pre-operative nutritional drink.
• You should expect to be off the ward for several hours.
• After your operation, the nurses will check your blood pressure, pulse, oxygen levels, temperature, hip wound and the feeling in your legs at frequent intervals

Things from home to bring in:
• Your regular medications (with packaging)
• Toiletries e.g. toothbrush, toothpaste, soap, flannel, comb, shaving equipment etc
• Day and night clothes
• Supportive nonslip footwear (slippers or shoes) – you will be getting up the day after your operation
• Glasses / hearing aids
• Walking aids
• Small remembers from home may be beneficial

First day after your operation

You should expect…
• To be seen by the physiotherapy team. If you are medically stable they will help you to get out of bed and start walking. You will be encouraged to get out of bed every day and you will have exercises to do on the bed and standing up. This will help with hip strengthening.
• To be seen by the occupational therapy team. They will come and talk to you or your family about your home and how you manage with daily tasks such as washing & dressing, cooking, cleaning etc. They will also ask for some furniture heights in order help with independence on discharge (See height sheet).
• You will have a blood test and may require a blood transfusion (this will discussed in detail with you or your family if required).


Ongoing rehab
• If you have a catheter in, it will be removed at the earliest opportunity.
• Continue to eat and drink plenty and this will be supplemented with nutritional drinks (i.e. Ensures)
• You will be encouraged to regain your independence with your normal daily activities.
• If you have stairs at home, the physiotherapists will practice this with you in hospital. If you are struggling to manage the stairs, we may advise downstairs living initially on discharge home. This will be discussed with you and your family.
• If required, the Occupational therapy team may do assessments with you e.g. washing & dressing, and kitchen assessments. Any aids you need at home will be arranged too.

Expectations on discharge…
• You are likely to be deemed fit for discharge by the doctors before you are deemed ready to go home by the therapy teams.
• If you walked independently prior to your fracture, you should expect to use a walking aid on discharge. You are likely to require further input by the physiotherapy team once you return home.
• The Occupational therapy team may refer you to other services in the community that you may benefit from.
• Underlying conditions, particularly Dementia and Parkinson’s disease are likely to impact the recovery following a hip fracture. Your needs will be continually assessed by the team, and may require higher levels of care on discharge than prior to your fracture.
• Dalteparin injections (to reduce the risk of blood clots) – this may have been started during your admission. You or your family will be encouraged to administer once you are home if necessary. You will be taught how to do this by the nursing team if required.
• Wound care- you usually have your stitches or clips removed 10-14 days after your operation. If this is not done before your discharge, you may require to go to your Practice Nurse for this or if this isn’t possible a District Nurse visit will be arranged.
• Mediations of discharge- you will be given pain relief and any other medications you require to go home with. Please be patient with pharmacy, it may take a while.
• Transport – hospital transport can be organised for you if it is not possible for your family to take you home.

Follow ups
• As part of our participation with the NHFD you will be contacted by the Specialist Fragility Nurse approximately four months after your admission. This is to find ask about your mobility and bone protection medication.
• If you require a follow up by the surgeon this will be organized for you by the hospital and your appointment sent to you.
• You will be referred to the Falls Service on discharge.

Ward Information
Ward 23 – 01908 995472
Visiting times: 10am-8pm
Please limit visitors to 2 at any one time. The ward operates a “no flower policy”. It is inadvisable to bring children under the age of 5 to the ward due to infection risks.

Other Useful Contacts
• Age UK- 01908 550700 www.ageuk.org.uk

• Wiltshire Farm Foods-0800 077 3100 www.wiltshirefarmfoods.com

• National Osteoporosis Society- 0808 800 0035 www.nos.org.uk

• Milton Keynes Falls Service- 01908 650405

Osteoporosis is a condition of the bones that makes them fragile and at risk of breaking following a fairly ‘minor’ fall or accident and there are usually no symptoms prior to this.

Who is at risk?
Anyone can get osteoporosis but women are four times more likely than men to develop it. However there are some risk factors associated with osteoporosis:
– Steroids (often used for inflammatory conditions such as rheumatoid arthritis).
– Early menopause (characterized as before the age of 45).
– Heavy smoking.
– Higher than recommended alcohol intake.
– Poor diet (particularly a lack in calcium and Vitamin D).
– Family history (either of osteoporosis or of hip fractures).

Diagnosis and Treatment
Your risk of further fractures and osteoporosis will be assessed whilst you are in hospital. Depending on the outcome of this assessment will depend on the course of action taken next. You may require further investigations such as a DEXA scan (which will occur after your discharge as an outpatient if required). You will have some tests added to your routine blood test whilst in hospital to check your Vitamin D levels, your Bone profile and Thyroid function. Depending on your results, you may require some supplementary medication to improve some of these results to improve your bone quality. This will be discussed with you or your family if necessary.

Treatment is varied but is often in the form of a bisphosphonate medication. These medications work by slowing down the bone turnover process, stopping the bones from breaking down and allowing them to build uptherefore increasing the bone density. Other alternative treatments are available if this type of medication is not suitable for you or give you unwanted side effects.