Hip fractures are relatively common among the elderly. Fragility fractures are those that occur as a result of low-energy trauma.
Dr. Ratnav Ratan, an Excellent Pediatric Orthopedic Specialist from Delhi, says, “Hip fractures are relatively common among the elderly. Fragility fractures are those that occur as a result of low-energy trauma. “
A minor fall or jerk causes a break in a bone that is already weak. For several years, weak bones have been associated with old age, particularly in postmenopausal women. They are more susceptible to such fractures if they are not being treated for osteoporosis.
In comparison to previous generations, we now have a massive population of older adults.
This is due to a better way of life, better medical facilities, and a better understanding of senior issues. The number of hip fractures is increasing proportionally. These fractures were once thought to be the beginning of the end.
“We enter the world through the brim of the pelvis and exit the world through the neck of the femur,” was a famous saying in the past.
“However, thanks to advancements in medical science, safer anesthesia, and better implants, almost all patients who have had these fractures can return to their previous way of life. It is no longer considered the start of the end,” says Dr. Ratnav Ratan, the leading Pediatric Orthopedic doctor from Delhi.
Diabetes Mellitus, hypertension, ischemic heart disease, renal pathologies, bronchial asthma, stroke with paralysis, Alzheimer’s disease, and other comorbidities are common in older adults, complicating management.
There are two types of hip fractures:
- Intracapsular femur fractures are those that occur close to the femur’s head.
- Extracapsular, which are located at the intersection of the neck and the femur shaft.
However, the fractures are only about an inch apart. Because of the anatomy of the femur’s neck, they have distinct characteristics.
Extracapsular fractures have a better blood supply and heal faster, whereas intracapsular fractures do not heal well due to the distribution of blood vessels.
Because blood is supplied to the head of the femur through the neck of the femur, the blood supply is compromised in fracture cases.
The person is unable to bear weight on the leg due to a hip fracture. The fracture does not heal, and the femur head becomes avascular and can die as a result.
When an older person is up and about, he is in the best of health; however, when he is bedridden, various complications of recumbency are likely to arise.
The following are some of the issues with recumbency:
1: Circulatory problems:
The thromboembolic phenomenon is one of the most common circulatory problems. There is a good chance that a thrombus will form in the calf muscle veins due to the stagnation of blood flow.
According to Dr.Ratnav Ratan, the specialist from Delhi, this thrombus can cause sudden death if it forms emboli and lodges in the pulmonary veins. The same can get stuck in the brain vessels, causing paralysis.
Early mobilization of the patient can solve these dangerous problems.
2: Respiratory complications:
Because of the constant lying down, the chest expansion is compromised. Consolidation of the lungs may result as a result of this.
The liquids that older people drink are rarely aspirated, leading to complications such as aspiration pneumonia. This, too, is a potentially fatal complication.
3: Bedsores:
also known as pressure ulcers are a common ailment among bedridden people. They appear in areas of the body that come into contact with the bed, particularly over a bony prominence.
The blood supply is compromised due to constant pressure on the skin, and the skin and underlying tissues die, resulting in an ulcer.
The only way to treat bedsores is to relieve the pressure by moving around as soon as possible. The best treatment for bedsores is prevention.
4: Kidney complications:
To avoid the problem of passing urine in bed, most older adults avoid drinking enough water.
This results in an increase in blood urea levels as well as an electrolyte imbalance. In addition to infection, the indwelling catheter has its own set of issues.
There is a risk of septicemia in the elderly due to a lack of immunity, especially in diabetic patients.
5: Psychological issues:
Depression is common among the elderly due to their recumbency. It occurs more frequently in patients who lack adequate family or financial support.
Their participation in the rehabilitation program becomes difficult due to their depression.
All of the issues listed above are medical. However, many social problems are associated with the fractured elderly as a result of changing demographic patterns.
In nuclear families, the older person frequently lives alone or lacks a responsible relative who could be held accountable.
We frequently see older adults with hip fractures whose children have settled or are working in another country. There are no close relatives who can assist.
The goal of hip fracture treatment is for the patient to be pain-free and ambulatory. Only surgical methods will be able to achieve this goal.
Non-operative treatment has no place in the management.
Non-union and avascular necrosis of the head of the femur are common after a fracture of the neck of the femur; prosthetic replacement is the best treatment.
This is a straightforward procedure that allows for rapid mobilization and ambulation.
Fractures around the trochanters, likewise, can be effectively treated with special devices. Fixation of a fracture like this allows for early and pain-free ambulation.
The surgeries come with a certain amount of risk. The risk varies depending on the comorbidities present. All medical issues must be resolved before the patients can undergo surgery.
In people with diabetes, blood sugar control should be reasonable, as should correction of low hemoglobin, renal parameters, and electrolytes.
Surgery must be postponed for at least a week after the use of blood thinners has been discontinued.
Because of the various problems associated with recumbency, such as those mentioned earlier, avoiding surgery is also a risk.
The outcome of a conservatively treated Trochanteric Fracture is always unpredictable. Most of the time, the person succumbs to one or more of the recumbency’s complications.
When the two options are weighed, the operative treatment comes out on top. A team of physicians, orthopedic surgeons, anesthesiologists, and a good physiotherapist must work together to ensure a good outcome for elderly hip fractures.
Each of them has a specific role in the management, and they all need to work together to achieve success.
The best treatment for hip fractures in the elderly is prevention.
It is possible to avoid this mishap if specific guidelines are followed:
- Avoid clutter in the house: Many falls occur due to items such as toys, loose carpets, and dog chains, among other things, being left on the floor.
- Proper lighting in the home: Because most older adults have poor vision, dim lighting is not a good idea. A flashlight or a light switch should be kept close to the bed.
- Hearing aids: Hearing loss is frequently the cause of falls or accidents. Hearing aids should be used whenever possible to avoid such mishaps.
- Dentures: When someone has difficulty chewing, they tend to avoid protein-rich foods. Osteoporosis develops as a result of this, which can lead to hip fractures.
“When taking a stroll or walking outdoors, proper clothing and footwear, as well as a walking aid such as a walking stick, can help prevent falls, especially in wet weather,” says Dr.Ratnav Ratan.
A hip fracture is a misfortune in the life of the older adult and his family. Fortunately, modern treatment has consistently produced positive results.
The risk-benefit ratio should be weighed by the treating doctor and the patient’s family before deciding. If surgical treatment is recommended, there should be no hesitation in opting for it.
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