KOCHI: One night, I got a frantic call from an old classmate of mine in the UK. He said his 80-year-old mother fell at home while cooking and sustained a hip fracture. I knew her from our medical college days but her health had been deteriorating over the last few years. She was diagnosed with diabetes and had had a minor stroke a few months back. She was on medication, including blood-thinning agents. Despite all this, she was mobile and independent.
During the fall, she suffered a displaced fracture involving the ball of the hip joint (neck of femur) and needed hip replacement surgery. She was admitted to the hospital and was assessed by a multidisciplinary team. She was operated on within 24 hours. Gladly, she made an uneventful recovery.
Causes
Fractures around the hip joint are common in the elderly and often happen after trivial falls. There is always an element of osteoporosis that makes the bones fragile leading to a fracture.
Diagnosis
Whenever an elderly person has had a fall and has pain around the hip or cannot stand up, it is most likely due to a fracture. Most of the time an X-ray is enough to diagnose this.
Treatment
Generally, if the person was mobile before, surgery is required despite their age. These days, even when the person is on blood-thinning medication, the advice is to not delay surgery.
Invariably, the question raises if it is safe to do surgery on an elderly person. Without surgery, these patients tend to develop multiple complications, including chest/urinary infections and fatal blood clots. However, after a well-done operation, these patients can be mobilized early, which reduces the risk of these complications. Anaesthesia and surgery do bring in their share of complications, but it increases their chances of survival. Studies have shown that surgery within 48 hours of the fracture reduces the risk of complications.
Aftercare
The fracture has to be fixed to allow the patient to regain mobility bearing full weight from day one. It would be counterproductive if these patients, after having surgery, are kept on bed rest. The techniques of surgery have improved tremendously in recent years giving surgeons more confidence.
Preventing a fracture
Doctors will try to identify any concrete causes leading to the fall. Normally most of these patients undergo bone density checking using a DEXA scan. If the bone density is low, there are several medicines available now that can help reduce the risk of a fracture.
Normalcy after hip fracture
The adage says “we come into the world through the pelvis and go out through the neck of the femur”. This implies that most patients used to die from hip fractures back in the day. This has changed now and early surgery has become a lifesaver. Encouragement and support from loved ones are extremely important during the recovery process. Most patients will take up to a year to fully recover from this type of injury.