Hip fractures in the elderly are one of the most serious consequences of falls and a public health problem, as they are associated with high costs in the treatment and rehabilitation of the elderly. This is not only a cost for the elderly and their families, but for society as a whole, given that the vast majority of treatment is carried out by the SUS (Brazilian public health system) and after the fracture, many lose their independence, becoming dependent on constant assistance, limiting the work activity of the family member who remains committed to this assistance. The other perverse side of this fracture is even more serious due to its association with a high mortality rate, reaching more than 50% in one year, in people over 80 years of age.
The main and most effective measure to combat hip fractures is PREVENTION. (Prevention of fractures in the elderly)
Elderly people are the main victims of these fractures due to physiological changes and diseases that are more common in aging. Diseases such as osteoporosis, which are more prevalent with advancing age, contribute to an increase in bone fragility and therefore, a simple fall can have serious consequences.
In addition, other diseases that are more common in old age contribute to an increased risk of falls, such as osteoarthritis of the knees and hips, reduced vision, sarcopenia (muscle loss), use of multiple medications and neurological diseases are some examples that can affect muscle strength, balance and facilitate the occurrence of falls.
Hip fracture refers to a group of fractures of the proximal femur. The most common are femoral neck fractures, transtrochanteric fractures and subtrochanteric fractures .
Treatment of hip fractures
There are two main treatments for hip fractures: one is osteosynthesis (fixing the bone with plates, screws or an intramedullary rod) and the other is replacement of the hip with a prosthetic joint (hip replacement).
A hip prosthesis
is used when there is a displaced femoral neck fracture . Displaced fracture means that in addition to the fracture of the neck, there was also displacement of the fragments. When there is this type of displaced fracture, it is well established in medicine that the results of fixing this bone are very poor, given the high complication rates, with the possibility of requiring further surgery reaching over 50%. This happens because the blood vessels that supply the femoral head are usually damaged at the time of the trauma, resulting in avascular osteonecrosis of the femoral head (death of the femoral head) or pseudarthrosis (bone does not heal). In these cases of displaced femoral neck fractures, a hip prosthesis is the best treatment option.
In all other hip fractures ( non-displaced femoral neck fracture, transtrochanteric fracture and subtrochanteric fracture ) the goal will be osteosynthesis of the femur, allowing the patient to continue with their natural hip. However, care must be strictly followed until bone consolidation (the bone has reattached) is identified on the radiograph. Although saving the natural hip is an excellent treatment, it does not mean that there will be complete recovery to the pre-fracture state.
Recovery
Patients will usually be discharged from the hospital two days after surgery. Some patients will be able to walk the day after surgery, while others will be able to walk only after the bone has healed. The surgeon will determine who will be able to walk before or immediately after surgery.
Pain relief
Pain after surgery is expected, but the patient should use prescribed medication for comfort, to avoid suffering and to facilitate recovery.
Medications are often prescribed for short-term pain relief after surgery. Several classes of medications can be used to relieve pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and analgesics. Your doctor may use a combination of these medications to improve pain relief while minimizing the need for prescription medications.
Rehabilitation
Mobilization after surgery is essential. Patients may be encouraged to get out of bed the day after surgery with the assistance of a physical therapist. The amount of weight that is allowed to be placed on the operated leg will be determined by the surgeon and is usually dependent on the type of fracture and the surgery.
The physical therapist will work with the surgeon to restore the patient’s strength and ability to walk. This process may take several months.
Risks during hospitalization
A blood transfusion may be needed after surgery, but is usually not necessary.
Most patients will be given medications to “thin” their blood and reduce the chances of developing blood clots. These medications may come in the form of pills or injections. Elastic compression stockings or inflatable compression boots may also be used.
Post-surgery consultations
After surgery, the surgeon must monitor the patient regularly, checking the surgical wound, advising when to remove sutures, and performing a sequential evaluation of X-rays to ensure the bone consolidation process and prevent the development of possible complications. In addition, the surgeon must assess the speed of recovery by prescribing physical therapy.
After hip fracture surgery, most patients will regain much, if not all, of the mobility and independence they had before the injury.
Conclusion
Fractures in the elderly represent a significant health challenge that can lead to serious complications and decreased quality of life. Understanding the causes, risk factors, and treatment options is essential for both healthcare providers and caregivers. By focusing on prevention through proper nutrition, exercise, and fall-risk assessments, we can help reduce the incidence of fractures in this vulnerable population. Increased awareness and proactive management can empower older adults to maintain their mobility and independence, ultimately improving their overall well-being.
FAQs
1. What are the most common types of fractures in the elderly?
Common fractures in the elderly include hip fractures, wrist fractures, and vertebral fractures.
2. What causes fractures in older adults?
Fractures in the elderly are often caused by falls, osteoporosis, and other age-related factors that weaken bones.
3. How can fractures be prevented in the elderly?
Preventive measures include strength training, balance exercises, a healthy diet rich in calcium and vitamin D, and home safety assessments.
4. What is the recovery process for elderly patients with fractures?
Recovery typically involves medical treatment, physical therapy, and possibly surgery, depending on the fracture’s severity.
5. Are there long-term effects of fractures in the elderly?
Yes, fractures can lead to complications such as decreased mobility, chronic pain, and an increased risk of future falls and fractures.
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