Question

what is the interprofessional care for hip fracture secondary to osteoporosis

Answer 1

Collaborative mangement includes the following

Traction

Initially the affected extremity may be temporarily immobilized by Buck's traction, until the patient's physical condition is stabilized and surgery can be performed. Buck's traction relieves painful muscle spasms and is used for upto 24-48 Hrs

Surgical management

Surgical treatment of hip fracture permits early mobilization and decrease the risk of major complications. The type of surgery depends on the location and severity of the fracture and person's age. Surgical Options include the following:

1. Repair with internal fixation device (Hip compression screw, intramedullary devices)
2. Replacement of part of femur with a prosthesis (Partial Hip replacement)
3. Total Hip replacement (replacement of femur and acetabulum)

Whenever possible, teach the patient the method for exercising the unaffected extremity and both arms. Encourage the patient to use the overhead trapeze bar and opposite side rail to assist in changing positions. A physical therapist can begin to train and teach out-of-bed and chair transfers

Inform the care giver about patient weight bearing status after the surgery

Post-operative management

Immediate Post OP

• Assess vital signs, intake-output
• Monitor respiratory function, deep breathing and coughing
• Administer pain medication
• Observe the dressing for signs of bleeding and infection

Early Post-operative period

There is a potential for neurovascular impairement. Assess the patient's extremity for:

• Color
• Temperature
• Capillary refil
• Distal Pulses
• Edema
• Sensation
• Motor function
• Pain

Edema is alleviated by elevating the leg whenever the patient is in a chair.The pain resulting from the poor alignment of the affected extremity can be reduced by keeping pillows (or an abductor pillow) between the knees when the patient is turning to either side

PATIENT AND CARE GIVER TEACHING GUIDE AFTER HIP REPALCEMENT

Do's

Do N'ts

Use an elevated toilet seat Place chair inside shower or tub and remain seated while washing Use pillow between legs for 6 weeks after surgery when lying on non-operative side or supine Keep hip in neutral straight position when sitting, walking or lying Notify surgeon if severe pain deformity or loss of function occurs Inform dentisit the presence of prosthesis before dental works so that prophylactic antibiotics can be indicated

Force Hip into greater than 90 degress of flexion (e.g: sitting in low chairs or toilet seat) Force hip into adduction Force Hip into internal rotation Cross legs at knees or ankles Put on own shoes or stockings without adaptive device(e.g: long handled shoe horn or stocking helper) until 4-6 weeks after surgery Sit on chairs without arms . They are needed to aid rising to a standing position

Adjuanct Therapy

• Calcium supplementation
• Nutritional Therapy
• Exercise Therapy
• Pharmacologic therapy

Prevention and treatment of osteoporosis focuses on adequate calcium intake (1000 mg/day in pre-menopausal women and post menopausal women taking estrogen, 1500 mg/day who are not taking estrogen supplement)

Foods High In Calcium

• Whole and skim milk
• Yogurt
• Turnip greens
• Cottage cheese
• Icecream
• Sardines
• Spinach

If dietary intake is inadequate, supplemental calcium may be recommended. Calcium is difficult to absorb in single doses greater than 500mg. Teach the patient the importance of taking supplemental calcium in divided doses with food

Vitamin D is important in calcium absorption and function and may also have a role in bone formation. Most people get enough Vitamin D through their diet or by naturally through the synthesis in the skin from exposure to sunlight. Being in the sun for 20 minutes a day is generally enough. However, supplemental Vitamin D (800-1000 IU) is recommended for post menopausal women, older men those who are home bound and those who get minimal sunexposure

Physical Activity

Physical therapist usually supervises exercises for the affected extremity and ambulation when the surgeon permits it. The patient is usually out of bed in the first post operative day. In collaboration with the physical therapist, monitor the patient's ambulation status for proper use of crutches or a walker . For the patient to be discharged home, have the patent demonstrate proper use of crutches or a walker, the ability to transfer into and from a chair and bed and the ability to ascend and descend stairs

Weight bearing of especially fragile fractures may be restricted under X-ray examination indicates adequate healing, usually 6-12 weeks

Regular physical activity is important to bulid up and maintain bone mass. Exercise also increases muscle strength, coordination and balance. Walking is preferred to high-impact aerobics or running, both may put additional stress on the bones, resulting in stress fractures. Walking 30 minutes 3 times a week is recommended

Instruct patient to quit smoking and cut down alcohol intake to decrease the likelihood of losing bones. Make an effort to keep osteoportic patients ambulatory to prevent further loss of bone substance as a result of immobility

Treatment may also involve use of gait aid as needed and to protect areas of potential pathologic fractures. For e.g: a thoracic-lumbar-sacral orthosis (TLSO) brace may be used to maintain the spine in proper alignment after a fracture or treatment of a vertebral fracture

Pharmacologic mangement

Main goal is to increase bone density and to decrease bone loss and thus the likelihood of fracture, especially in patients with osteoporosis

• Calcium and Vitamin D supplementation
• Estrogen replacement
• Bisphosphonate drug therapy