Written by Brandon Leonard, MA and Adam Bitterman, DO
Hip fractures often require surgical intervention. There are a limited number of circumstances where performing surgery would not be the treatment of choice including:
- patients designated for hospice/palliative care, and
- clinical situations where the risks of surgery far outweigh the benefits.
Hip fracture injuries tend to be life-altering events. It is important to understand the risks associated with them as well as the possible benefits for fixing them. Communication is key in order to have a successful outcome. Prevention is your first line of defense, yet, when that fails, the next option is having a support team, including your surgeon and their associate staff, get you out of the hospital with a successfully fixed hip. Here, we provide a comprehensive reference to assist those patients and family members as well as members of one’s support team, going through this process and to alleviate the stressors associated with surgery.
Preoperative Questions:
How do I know surgery is the best option? Hip fractures are not a benign condition. They need to be addressed and they need to be dealt with quickly. These are not life-or-death emergencies but they do have an associated morbidity and mortality for every day that passes without resolution. If a hip fracture is not fixed, the patient must not place any weight on the injured leg and is required to be bed bound for an extended amount of time. With this comes a high risk of pneumonia, skin breakdown, failure to thrive, and ultimately death. A break of one’s hip is an indication for surgery in order to get them back to their pre-surgical function. Unless someone is a non-ambulator without any pain or a patient seeking palliative care, it is encouraged that all hip fractures be fixed.
What are the risks associated with performing an operation? Surgery comes with significant risks. With regards to orthopedic surgery, the risks include but are not limited to:
- Failure of the bone to heal
- Failure of the hardware implanted
- Infection
- Bleeding--It is important to understand the need for possible blood transfusion. Hip fractures cause bleeding even before the skin is cut. If you have religious restrictions to any blood products, please inform your surgeon immediately.
- Skin breakdown
I have heard a lot about anticoagulation and their usage with hip fracture care, but what is it all about? Anticoagulation is another term for what is commonly known as blood thinning medication. These drugs are crucial to a successful outcome. When one is bed bound after a fracture, their blood will pool in the legs and is at a high risk to clot or become extremely thick. What these medicines do, is prevent that clotting mechanism from happening. These clots may eventually break free and put you at risk for life threatening events including a pulmonary embolism. Be sure to discuss this with your doctor and mention any blood thinning medicines that you may already take.
How do I know I have the right doctor? Do your research! Be sure to find out if your doctor is board certified or board eligible. Also, don’t be afraid to ask about their experience with your particular fracture. It is important to be your own advocate.
Intraoperative Questions:
How long is my surgery? A successful operation has three components. First the patient needs to be given the appropriate anesthesia which is determined by your anesthesiologist. Once that is completed, the patient needs to be properly positioned. The second component of the surgery is the actual procedure. For hip fracture management, the time frame may range from thirty minutes to two hours. These values are a range. There is no way to provide an exact time frame. The third portion of a procedure is the wake up or post-procedure component. After the wounds are closed and the dressing is in place the patient is brought to the recovery room and monitored continuously. The first and third segments add an additional half hour to one hour on top of the actual surgery time. Of note, do not panic if the provided time frame has elapsed and you have not heard from your loved one’s team. Stay calm and understand that the surgeon is focusing on providing the best surgical care and will notify you at an appropriate time.
Who will be doing my surgery? Without a doubt, your surgeon will be present at the time of the operation along with his or her assistants. The assistants may range from associate attending physicians to resident physicians or physician extenders, physician assistants. It is important to understand that your surgeon will be present for the duration of your procedure and is involved in every aspect of it.
Postoperative Questions:
Will I need to go to rehab? The answer to this question depends on your functional status before your injury. If you are able to handle your post-operative therapy from your home or a private physical therapist’s office than that is something to consider. However, if you have three flights of stairs in your home and do not think you will be able to make it to the bathroom without appropriate assistance then it is recommended that you seek rehabilitation at a facility that can accommodate you.
What is the recovery time with my injury? Your recovery time depends on your pre-fall functional level. Also, with the right amount of support from family and friends your recovery time may be shorter. Overall, the time frame to recovery is extremely patient specific.
Brandon Leonard, MA, is an Emergency Medical Technician certified in Critical Care. He works with the Nassau County Police Department in Long Island, New York and is the Senior Vice President – Emergency Services and Community Projects for JAMB Innovations. Adam Bitterman, DO is an Orthopedic Surgery Resident in Long Island. Dr. Bitterman is the CEO and co-founder of JAMB Innovations, a dynamic concierge mobile medical application development company. For more information, go to www.jambinnovations.com.�
