Hip Fracture Education for Patients & Families

At Beacon Health System, we understand that a hip fracture can be a painful, frightening and sometimes life-changing event. We are here to help you understand what to expect every step of the way, providing the specialized care you need throughout your treatment and recovery. Our goals include: timely surgery, early mobilization with therapy after surgery, a teaching approach to assess your needs and timely discharge to get you working towards your pre-fracture walking ability.

Plan Ahead

Discharge planning is key to helping you get out of the hospital and on your way to recovery as quickly as possible.

• Learn what to expect and start putting your plan together today (Download PDF).
• See our “After Discharge” section for more information.

What is a hip fracture?

A hip fracture is a break in the femur (thigh bone), the largest bone in the body. The hip is a ball-and-socket joint where the femur joins the pelvis. Hip fractures can occur at the head, neck or upper shaft of the femur. The break may be non-displaced (the bone is broken but remains in place) or displaced (the bone has moved out of place).

Hip fractures often occur after a fall, whether you have osteoporosis or not. Osteoporosis is a very common disease that weakens your bones and makes them brittle. It can greatly increase your risk for fractures, even with a small fall.

Before Surgery

If you’ve had a hip fracture, you most likely came to the hospital Emergency Department where several tests are done, including x-rays and blood work. These tests confirm that a fracture occurred and determine if you need surgery. If so, our goal is to perform the surgery within 24 hours of your injury. If more extensive medical tests are needed, your surgery may be delayed.

Why do I need surgery?

Surgery is the most common treatment for a hip fracture. The goal is to align the bones so they heal correctly, giving you the best chance to get back to the things you did before your facture – with as little pain as possible.

If you are at high risk for complications from surgery, medication and rest may be prescribed. This option may also be recommended for people who won’t significantly benefit from surgery, such as those who were unable to walk before the fracture or those who have minimal pain.

Who is on my healthcare team?

Hip fractures are best treated with a team approach. You and your family are an important part of your care team, especially when it comes to decisions before, during and after your treatment. Your team will also include:

• An orthopedic surgeon who will diagnose your hip fracture and work with you to decide the best treatment option and perform your surgery.
• A hospitalist – a medical doctor that cares for patients admitted to the hospital. This doctor will manage your medical conditions and coordinate your care with any specialists as needed.
• Nurse Practitioners (NP) and Physician Assistants (PA) that provide daily care and assist surgeons and hospitalists while you are in the hospital.
• Nurses and nursing assistants who will provide your daily care, help keep you comfortable and manage your pain during your stay.
• A case manager or social worker who will discuss your discharge plan, living situation and insurance with you and your family.
• Physical therapists (PT) who will teach you exercises that build strength and help you recover. They will also teach you how to get around safely while you heal.
• Occupational therapists (OT) who will teach you how to safely do daily activities as you recover.

Your Surgery

Your type of surgery depends on the type and severity of the fracture, condition of the bone and your overall health. Your surgeon will talk with you about what will happen during your specific surgery, which may require stabilization of the bone with screws, a hip nail or a partial or full hip replacement depending on the fracture type.

What should I expect before and during surgery?

Before your surgery, a member of your anesthesia team will talk with you about the types of anesthesia they may use – general or spinal anesthesia. The anesthesia you will receive is determined by your health, your input and any concerns of the anesthesiologist. An additional injection with regional nerve block anesthesia (fascio-iliaca) has been shown to help control pain and may be needed for pain after surgery.

Here’s what to expect:

• Your surgeon or another health care team member writes your surgeon’s initials on the hip that is fractured. This safety measure ensures that everyone in the operating room knows which hip needs repair.
• You will be asked to empty your bladder. A catheter may be placed in the bladder during surgery and kept there for a few days.
• Remove all jewelry (including rings), contact lenses and nail polish. You may wear your glasses, hearing aid or dentures, but these will be removed in the surgical area before your surgery. They will be available to you immediately after surgery.
• The hip that will have surgery may be shaved and will be cleansed.
• An intravenous (IV) line may be started to give you fluid and medication through a vein.
• You will be taken to the preoperative waiting area. Your family members and friends will be shown where to wait while you are in surgery.
• Surgery typically takes from one to three hours. Sometimes blood transfusions are needed during surgery. Casts, splints and traction devices are not needed after repairing a hip fracture.

After Surgery

After your surgery, you’ll be moved to the Post Anesthesia Care Unit (PACU), also called the recovery room. You’ll stay there until the anesthesia wears off and you are stable. This usually takes a few hours. You will then be moved back to your hospital room.

You will stay in the hospital for about three to four days after surgery. In the hospital you’ll work on physical therapy, occupational therapy and pain management.

How soon will I be out of bed?

It is important that you don’t stay in bed too long after your surgery. Physical therapy will begin the day of your surgery or the next morning, depending on the time of day your surgery is scheduled. Your goal is to increase your activity a little each day to build your strength and continue your recovery outside of the hospital. It may seem hard at first, but moving your body speeds recovery and helps prevent problems. Depending on your specific needs, your orthopedic surgeon may or may not restrict weight-bearing activities such as walking after your surgery.

How will my pain be managed?

Even with medication, some pain is normal after surgery. You will receive pain medication by taking pills or through an IV. Ice packs can also be used to help lessen pain and swelling. The goal is to reduce your pain enough so that you can do the physical therapy exercises that will help you heal and regain as much independence as possible. Talk to your doctor or nurse if your pain isn’t controlled and you are very uncomfortable. Be aware that some pain medications, such as narcotics, can cause confusion or disorientation for a time, as well as constipation. Our goal is to adequately treat your pain with a combination of medications and discontinue narcotics in a timely manner.

After Discharge

What happens when I leave the hospital?

You can leave the hospital when your doctor determines that you are medically stable. The next step of your treatment plan depends on how well you can safely move around. Your safety and the prevention of falls is a priority often overlooked and underestimated by patients and families.

Recovering from a hip fracture is not easy; it takes a lot of hard work and can take from three months to a year to heal. With proper care and rehabilitation, some people may return to pre-injury levels of activity and independence. Less than half of all patients regain their previous level of function. It’s possible you may need more assistance or devices such as a cane or walker.

Although most hip fracture patients would like to return to their home or the home of a loved one after leaving the hospital, this may depend on the level of care and resources you need. It’s important to consider the following questions before leaving the hospital:

• How is your overall health?
• Do you need more care than is practical/available to provide at home or a loved one’s home?
• Do you have a condition, such as dizziness or imbalance, that could lead to another fall?
• Do family members have the time and strength to provide full-time/24-hour care at home?

Keep in mind that:

• Your safety and the prevention of recurrent falls is our priority in deciding upon the right location for recovery after the hospital.
• A majority of elderly hip fracture patients require a skilled nursing facility after leaving the hospital.
• Your PT and OT will help identify the best setting to continue your recovery after you leave the hospital.  PT and OT will base this decision on your prior level of function, how you perform after surgery, and what help would be available to you after leaving the hospital.
• Patients and families can help choose a facility, but it will depend on your medical needs and your insurance coverage.
• Early decision making helps for a smooth transition out of the hospital.
• Discharge planning nurses and social workers will help with this process.

Follow your doctor’s orders. Depending on your surgery, your doctor will tell you what percent of weight you can put on your hip. If you were sent home with a walker, cane, crutches or wheelchair, be sure to use them.

Manage your pain well. Your doctor will recommend prescription or over-the-counter pain medications or both. If these don’t manage your pain well, call your doctor.

Continue your physical therapy. Do any exercises that your doctor or physical therapist recommend and continue to go to physical therapy as prescribed. Staying active will help strengthen your bones. Exercise is the most important thing you can do to ensure the best recovery possible.

Before you have any other procedures. Tell all your healthcare providers – even your dentist – that you have metal hardware in your. Dentists will ask you to take antibiotics before dental work to prevent infection if you have a partial or full hip replacement.

Blood clot prevention. Deep vein thrombosis (DVT) or pulmonary embolism (PE) are uncommon but potentially life-threatening complications after a hip fracture. Your doctor will often give you medication by mouth or injected into the abdominal skin for a period of time. Please let your doctors know if you or family members have a history of blood clots. If you took blood thinners before your hip fracture, please let the medical team know so they can decide which medications to use after surgery.

When to Call Your Doctor

• Fever of 101 degrees or higher
• Redness, swelling or leaking from your incision that worsens
• Pain in your calf that worsens
• Loss of feeling in your foot or leg
• Pain that is not controlled by medication
• Continued nausea or vomiting

When to Call 911

• Chest pain
• Difficulty breathing or shortness of breath
• Any reason you would normally seek emergency medical care

Follow-up Care

From discharge through recovery and beyond, there are things you can do to ensure you stay in your best health and prevent injuries in the future.

Follow-up visit. Ask your doctors when you should schedule a follow-up visit. This will usually be two to six weeks after surgery. You will also need to schedule an appointment with your primary care doctor.

Preventing fractures in the future. You can prevent fractures by strengthening your bones and avoiding falls. If you’re over 65, the most common cause of hip fractures is osteoporosis. If you have osteoporosis, ask your doctor how medical treatments can help. The following can help prevent osteoporosis and future fractures:

• Gradually increase your activity. Daily activities will become easier as you progress with your exercises and physical therapy. After you recover from surgery, a more active lifestyle can improve the strength of your hip and prevent fractures.
• Eat a healthy diet rich in vitamin D, calcium and protein. This can help strengthen your bones. Talk to your doctor about how much of each you need through diet and vitamins. Avoid nicotine and excessive alcohol or sugary drinks like soda.
• Protect against falling. Be especially careful about walking on stairs or wet/icy surfaces, getting out of the bathtub or shower and other situations where you may be at risk of falling. Make sure your home is safe to help avoid accidents. Have someone help you if necessary, and use a cane, walker crutches or handrails when needed.