Fracture Of The Hips

Hip Fracture

Etiology And Pathophysiology

  1. Fractures of the head or neck of the femur (intracapsular fracture) or trochanteric area (extracapsular fracture).
  2. 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

  1. Buck’s extension or Russell traction as a temporary measure to relieve the pain of muscle spasm or if surgery is contraindicated.
  2. Closed reduction with a hip spica cast in fractures of the intertrochanteric region.
  3. Open reduction and internal fixation.
    • Austism Moore prosthesis
    • Thompson prosthesis
    • Smith-Petersen nail
    • Jewert nail
    • Zickel nail
  4. Total hip replacement when joint degeneration will not permit an internal fixation.


  1. Shortening and external rotation of leg.
  2. Degree and nature of pain.
  3. Baseline vital signs
  4. Neurovascular status of involved extremity.
  5. 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

  1. Assess for complications of immobility.
  2. Encourage the use of a trapeze or side rails to facilitate movement.
  3. Use the fracture pan for elimination.
  4. Inspect dressing and linen for bleeding.
  5. Use a trochanter roll to prevent external rotation of legs.
  6. Do not turn client on the affected side unless specifically ordered.
  7. Place pillow between legs when turning on the unaffected side.
  8. Use pillows or abductor pillow to maintain the legs in slight abduction; after hip replacement it prevents dislodging of the prosthesis.
  9. Encourage quadriceps setting exercises.
  10. 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.
  11. Support on unaffected side.
  12. Avoid flexing the hips of a client with a total hip replacement, assist to a lounge chair position when permitted to sit.
  13. Prevent complication of thromboembolism:
    • Administer prescribed anticoagulants, observe for bleeding.
    • Apply antiembolism stockings.
    • Encourage dorsiflexion of feet.
  14. Prevent pulmonary complication.
    • Encourage coughing and deep breathing exercises.
    • Explain use of incentive spirometry.
    • Assist with frequent position changes.
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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.

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