Fracture Of The Hips
Hip Fracture
Etiology And Pathophysiology
- Fractures of the head or neck of the femur (intracapsular fracture) or trochanteric area (extracapsular fracture).
- Incidence highest in elderly females because of osteoporosis and degenerative joint disease.
Signs and Symptoms
- Pain
- Changes in sensation
- Affected leg appears shorter
- External rotation of the affected limb
Diagnostic Procedure
- X-ray examination reveals lack of continuity of the bone.
Therapeutic Interventions
- Buck’s extension or Russell traction as a temporary measure to relieve the pain of muscle spasm or if surgery is contraindicated.
- Closed reduction with a hip spica cast in fractures of the intertrochanteric region.
- Open reduction and internal fixation.
- Austism Moore prosthesis
- Thompson prosthesis
- Smith-Petersen nail
- Jewert nail
- Zickel nail
- Total hip replacement when joint degeneration will not permit an internal fixation.
Assessment
- Shortening and external rotation of leg.
- Degree and nature of pain.
- Baseline vital signs
- Neurovascular status of involved extremity.
- Other health problems that may affect recovery.
Nursing Diagnosis
- Constipation
- Fear
- Risk for injury
- Pain
- Impaired physical mobility
- Altered role performance
- Self-care deficit
- Situation low self-esteem
- Risk for impaired skin integrity
Nursing Interventions
- Assess for complications of immobility.
- Encourage the use of a trapeze or side rails to facilitate movement.
- Use the fracture pan for elimination.
- Inspect dressing and linen for bleeding.
- Use a trochanter roll to prevent external rotation of legs.
- Do not turn client on the affected side unless specifically ordered.
- Place pillow between legs when turning on the unaffected side.
- Use pillows or abductor pillow to maintain the legs in slight abduction; after hip replacement it prevents dislodging of the prosthesis.
- Encourage quadriceps setting exercises.
- Assist the client to ambulate by using a walker and eventually progressing to a cane; follow orders for extent of weight bearing permitted on affected extremity because this will depend on the type of surgery performed and the type of device inserted.
- Support on unaffected side.
- Avoid flexing the hips of a client with a total hip replacement, assist to a lounge chair position when permitted to sit.
- Prevent complication of thromboembolism:
- Administer prescribed anticoagulants, observe for bleeding.
- Apply antiembolism stockings.
- Encourage dorsiflexion of feet.
- Prevent pulmonary complication.
- Encourage coughing and deep breathing exercises.
- Explain use of incentive spirometry.
- Assist with frequent position changes.
image from hygenicblog.com
Daisy Jane Antipuesto RN MN
Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.
