Pathophysiology of Hip Fracture

Fracture of the proximal femur may be intracapsular (within hip joint and capsule), extracapsular, or intertrochanteric (outside the hip joint and capsule to an area approximately 5 cm below the lesser trochanter), and subtrochanteric (below the lesser trochanter).

Etiology: Falls

Risk factors:
• Osteoporosis
• Advanced age
• Female and Caucasian
• Decreased estrogen levels
• Prior hip fractures
• Alzheimer’s dementia
• Institutional residence
• Sedentary lifestyle

S&S:
• Severe pain at fracture site
• Inability to move leg
• Shortening and external rotation of leg

Dx: X-ray

Rx: Conservative management with traction or surgical repair.
Complications:
• Thromboembolism
• Pneumonia
• Alteration in skin integrity
• Voiding dysfunction

Nursing Process Elements
• Provide pain management
• Perform neurovascular assessment
• Maintain hip precautions (avoid hip flexion beyond 60 degrees, avoid adduction beyond midline, maintain weight bearing status per MD orders)

Client teaching for self-care
• Follow medication regime for pain management, anticoagulants, and/or treatment of osteoporosis
• Practice hip precautions (avoid hip flexion beyond 90 degrees for up to 2 months, avoid adduction past midline for up to 2 months)
• Monitor S&S of complications for thromboembolism, pneumonia, and infection
• Use adaptive or assistive devices
• Restrict weight bearing while ambulating
• Prevent falls
• Have sufficient dietary intake of calcium and vitamin D

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