Fractured Hip

  1. General information
    1. Fracture of the head, neck (intracapsular fracture) or trochanteric area (extracapsular fracture) of the femur
    2. Occurs most often in elderly women
    3. Predisposing factors include osteoporosis and degenerative changes of bone
  2. Medical management
    1. Buck's or Russell traction as temporary measures to maintain alignment of affected limb and reduce the pain of muscle spasm
    2. Surgery
      1. Open reduction and internal fixation with pins, nails, and/or plates
      2. Hemiarthroplasty: insertion of prosthesis (e.g., Austin-Moore) to replace head of femur
  3. Assessment findings
    1. Pain in affected limb
    2. Affected limb appears shorter, external rotation
    3. Diagnostic test: x-ray reveals hip fracture
  4. Nursing interventions
    1. Provide general care for the client with a fracture.
    2. Provide care for the client with Buck's or Russell traction.
    3. Monitor for disorientation and confusion in the elderly client; reorient frequently and provide safety measures.
    4. Perform neurovascular checks to affected extremity.
    5. Prevent complications of immobility.
    6. Encourage use of trapeze to facilitate movement.
    7. Administer analgesics as ordered for pain.
    8. In addition to routine post-op care for the client with open reduction and internal fixation
      1. Check dressings for bleeding, drainage, infection: empty Hemovac and note output; keep compressed to facilitate drainage.
      2. Assess client's LOC.
      3. Reorient the confused client frequently.
      4. Avoid oversedating the elderly client.
      5. Turn client every 2 hours.
      6. Turn to unoperative side only.
      7. Place 2 pillows between legs while turning and when lying on side.
      8. Institute measures to prevent thrombus formation.
        1. apply elastic stockings.
        2. encourage plantarflexion and dorsiflexion foot exercises.
        3. administer anticoagulants such as aspirin if ordered.
      9. Encourage quadriceps setting and gluteal setting exercises when allowed.
      10. Observe for adequate bowel and bladder function.
      11. Assist client in getting out of bed, usually on first or second post-op day.
      12. Pivot or lift into chair as ordered.
      13. Avoid weight bearing until allowed.
    9. Provide care for the client with a hip prosthesis if necessary (similar to care for client with total hip replacement).