What might go wrong?
The complications that can develop after a hip fracture are what make the injury a life-threatening problem. Some complications can result from surgery, but many can occur whether the fracture is treated with surgery or not.
Most of the complications that occur after a hip fracture result from having to put an aging adult on bed rest. In general, this seems to make all the medical problems the patient has worse. Some of the more common problems that a hip fracture can increase the likelihood of include:
- pressure ulcers
- mental confusion
Getting the patient out of bed and moving can reduce the risk of developing all these complications. If an operation is necessary to stabilize the fracture and get the patient out of bed quickly, this will actually reduce the overall risk of developing these complications. That doesn't mean that the complications may not still occur after surgery, but they are far easier to treat if the patient can be mobilized.
Most surgical procedures require that some type of anesthesia be done before surgery. A very small number of patients have problems with anesthesia. These problems can be reactions to the drugs used, problems related to other medical complications, and problems due to the anesthesia. Be sure to discuss the risks and your concerns with your anesthesiologist.
Bed rest can increase the risk of developing pneumonia in older patients. If anesthesia is required for surgery, the risk is even greater. After any injury that requires bed rest, you will need to do several things to keep your lungs working their best. Your nurse will coach you to take deep breaths and cough frequently. Getting out of bed, even upright in a chair, allows the lungs to work much better. As soon as possible, you will be allowed to sit in a chair.
The hospital's respiratory therapists have several tools to help maintain optimal lung function. The incentive spirometer is a small device that measures how hard you are breathing and gives you a tool to improve your deep breathing. If you have any other lung disease, such as asthma, the respiratory therapist may also use medications that are given through breathing treatments to help open the air pockets in the lungs.
Pressure Ulcers (Bedsores)
Hip fractures cause pain when you move, even in bed. As a result, you stop moving around to shift your weight from time to time as you normally would. When you are lying down, there is pressure on the skin in certain areas. This pressure actually stops the blood flow to the skin by closing off the blood vessels that go to that area. Usually this isn't a problem because you soon shift your weight, moving the pressure to another area. This shifting of the pressure allows the blood flow to return to the area of skin and prevents any damage.
But if something prevents you from shifting and the pressure stays constant in one area, that area of skin may eventually become damaged due to lack of blood flow. This damage is called a pressure ulcer or bedsore. The pressure causes the skin to actually die, similar to skin that has been burned with heat. First the area hurts, then it begins to blister, and then it turns into an open sore. These sores are difficult to heal if they are large. They may actually require a skin graft. They can become infected, causing other problems.
The best treatment is to prevent bedsores in the first place. Hospitals use special mattresses and special water beds to help distribute weight evenly in people who must be confined to bed. Nurses also routinely move patients in bed to make sure the skin is not getting too much pressure in one area. Still, the best way to prevent pressure ulcers is to get you out of bed and moving.
Thrombophlebitis (Blood Clots)
Thrombophlebitis, sometimes called deep venous thrombosis (DVT), can result from bed rest and inactivity. DVT occurs when blood clots form in the large veins of the leg. This may cause the leg to swell and become warm to the touch and painful. If the blood clots break apart, they can travel to the lungs, where they lodge in the capillaries (smallest blood vessels in the body) and cut off the blood supply to a portion of the lungs. This is called a pulmonary embolism. (Pulmonary means lung, and embolism refers to a fragment of something traveling through the blood vessels.) Most surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, but probably the most effective is getting you moving as soon as possible. Two other commonly used preventative measures include
- pressure stockings to keep the blood in the legs moving
- medications that thin the blood and prevent blood clots from forming
Aging adults who suffer a hip fracture and go to the hospital are under a lot of stress. Unfamiliar surroundings, pain medications, and the stress of the injury can lead to changes in a patient's behavior. This is sometimes called the sundowner syndrome because it seems to get worse at night. This can be very frightening to both patients and their families. Fortunately, it is almost always temporary. It can cause problems because patients can become difficult to handle and won't follow instructions. They may try to get out of bed and can damage the hip further.
The best treatment for mental confusion is usually to get patients moving and out of the hospital. Familiar surroundings, familiar faces, and activity are the best treatments. Medications are used when necessary, and it may be necessary to restrain patients during this period so that they will not hurt themselves further. Other medical conditions can cause confusion, and the doctor will make sure that these are not present. But, again, usually the mental confusion is temporary and will go away in a matter of days.