Hip Fracture Program The Joint Institute at Saint Barnabas Medical Center What’s Inside? } Welcome 1 } Understanding Your Hip and Hip Fractures 2 } Treatment Options 3 } Pelvic Fractures 3 } Having Orthopedic Surgery 4 } What to Expect Following Surgery 5 } Physical/Occupational Therapy 6 } Discharge Planning 8 } Post-Operative Care 9 } Preventing Future Falls 12 } Patient Contact List 13 Welcome Welcome to the Hip Fracture Program at Saint Barnabas Medical Center. The Hip Fracture Program was designed to empower our patients and their family members on their path to a quick recovery and optimal outcome after Hip Fracture Surgery. The Hip Fracture team has implemented a comprehensive planned course of treatment. We believe that you play a key role in promoting a successful recovery. Our goal is to involve you in your treatment through each step of the program. This guide will give you the necessary information to promote a more successful surgical outcome. The physicians, nurses, rehabilitation staff, and administration of Saint Barnabas Medical Center have worked together to assemble a multi-disciplinary team of specialists to create the Hip Fracture Program. This program is more than a specialized surgical program within Saint Barnabas Medical Center; it is also a comprehensive patient-centered care model for the surgical treatment. This program will help prepare and guide our patients and their families through the entire process of treatment from: } Preparation for surgery } Specialized post-operative care } Preparation for after medical center care/discharge We know for most patients that coming to the medical center for surgery can be an anxiety ridden process. The Hip Fracture Program is designed to address each patient’s fear and concerns about his/her treatment and empowers each patient with information and support in order to have the best possible outcome. It is our hope to deliver the best care for our patients and their family members during all phases of treatment for your hip condition. Our goal is to support you and your family through your treatment so that you can recover quickly and get back to the activities that you love. Hip Fracture Program – The Joint Institute at Saint Barnabas Medical Center 1 Understanding your Hip and Hip Fractures To further understand how hip fractures happen it is best to understand how the hip works. The hip joint is one of the true ball-and-socket joints of the body. The hip socket is called the acetabulum and forms a deep cup that surrounds Femoral Neck Fracture the ball of the upper thighbone, or femoral head. The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck. The bump on the outside of the femur just below the femoral neck is called the greater trochanter. This is where the large muscles of the buttock attach to the femur. Intertrochanteric Fracture Hip Fracture Facts } Falls are common – 1 in 3 seniors fall each year. } Falls are the leading cause of fatal and non- fatal injuries among people 65 and older in the United States. } About 3% of all falls cause fractures. The most common are fractures of the pelvis, hip, femur, What is a Fracture? spine, shoulder, wrist, forearm, leg, and ankle. } Falls increase with age – as many as 40 percent A hip fracture occurs when there is a break in the of seniors over 80 experience a fall. hip bone, usually in the upper part of the femur } About 50% of the elderly who sustain a fall- or the pelvis. Hip fractures are also a concern related injury will be discharged to a nursing for women who have gone through menopause home rather than return home. whose bones may have become thinner due to } Nursing home residents average approximately osteoporosis. Approximately one out of every 3 falls per year. seven women will experience a hip fracture. A hip } Fear of falling can make you more likely to fall. fracture may also lead to hip replacement surgery. } Women are 3 times more likely than men to be This is when an artificial prosthesis is used to hospitalized for a fall-related injury. replace the broken hipbone. } Half of the people who have a hip fracture never regain their pre-fall level of functioning. Most people who have had a hip fracture do not regain the level of independence they had before the injury. Approximately half of those who have had a hip fracture require some kind of assistive device, such as a walker, to ensure safe mobility. 2 Hip Fracture Program – The Joint Institute at Saint Barnabas Medical Center How do Hip Fractures Happen? or partial hip replacement is the best treatment option for your hip condition. Total or partial hip Hip fractures are typically caused by a fall. They replacement may offer relief for patients who are considered an orthopedic emergency and suffer pain and the loss of motion in the hip. require immediate attention and emergency treatment. People who suffer from osteoporosis Pelvic Fractures can be more at risk for hip fractures since their bones are less dense and more brittle and prone The pelvis is a ring-like structure of bones at to injury. Fractures can even be caused by simple the lower end of the trunk. The two sides of the weight-bearing activities. Although some fractures pelvis are actually three bones (ilium, ischium, are minor and cause only pain, other fractures and pubis) that grow together as people age. can be more severe. It is important to alert your Strong connective tissues (ligaments) join the physician if you experience any of the following hip pelvis to the large triangular bone (sacrum) at conditions: extreme hip pain that may radiate to the base of the spine. This creates a bowl like the knee, an inability to walk without a device such cavity below the rib cage. On each side, there as a crutch or cane, low back pain , an inability is a hollow cup (acetabulum) that serves as the to put any weight on the leg, and/or stiffness, socket of the hip joint. bruising or swelling in the hip or thigh . Unlike hip fractures, most pelvic fractures do not require surgery. They usually heal on their own. Treatment Options Patients with pelvic fractures are usually treated with pain medication and short periods of bed rest, Since hip fractures are considered an orthopedic followed by physical therapy. Physical therapy emergency, a benefit of treatment is relief of pain usually consists of light exercise and ambulation that results from the injury. training with an assistive device. Based on your general health and current medications, your doctor will plan the best form of treatment for you. X-rays and CAT scans or Magnetic Resonance Imaging (MRI) tests enable your doctor to make an informed decision regarding treatment. Hip fractures most commonly require emergency surgery by an orthopedic surgeon to restore the bones to their original position. During surgery, a surgeon may use metal devices such as rods to stabilize the bone and hold it in place. Bone grafts may also be needed to ensure adequate healing of the fracture. Total or partial hip replacements are sometimes performed for hip fractures if pain is severe enough to restrict daily activity or pain is not relieved by anti-inflammatory medicine for arthritis, or the patient has advanced arthritis or significant stiffness of the hip. Based on your medical condition, your physician will determine if total Pelvic Fracture Hip Fracture Program – The Joint Institute at Saint Barnabas Medical Center 3 Having Orthopedic Surgery at Saint Barnabas Medical Center Prior to Surgery PACU / Recovery Prior to your operation, hospital protocol requires The Post Anesthesia Care Unit (PACU) or that each patient undergo tests such as chest Recovery Room is where you will be transported x-rays, blood work, and electrocardiograms (EKG) after your surgery has been completed. In the to assess your overall health and condition.. Please PACU you will be assigned a bed space and a try to have all your questions answered about your nurse. Your nurse will be monitoring you very surgery and anesthesia before it is time to sign the closely as you begin your recovery from surgery consent forms. and the anesthesia that you were administered during surgery. As the nurse is performing his/ OR Holding her duties, a pain management specialist will come see you to begin the management of your pain/ Once your nurse is satisfied that you have been discomfort. Please be completely honest when prepped for surgery and the operating room staff is rating your level of pain or discomfort to the pain ready for your surgery, you will then be transported management specialist, we want you to be as to a staging area in the operating room called OR comfortable as possible. Once the PACU team Holding. Once it is time for you to be transported is satisfied with your progress, it will be time for into the OR Holding, your family member will you to have visitors. Visitors will be allowed in the be asked to wait for you during your procedure PACU two at a time. A volunteer at the Volunteer in the waiting area of the Surgery Center. Your Desk in the waiting area of the Short Stay Unit will family member will be given a number that they inform your family when it is the appropriate time can use in the waiting area to track your progress for you to have visitors. The volunteer will then through the surgery as it is updated by our OR direct the visitor to the PACU where the visitor will staff.