Caring for Elderly Patients with Femoral Fractures: Key Considerations

Care for Elderly Patients with Femoral Fractures

My grandmother fell and sustained a closed fracture of the femur above the knee on her right leg.
The doctor said that we need to wait for the swelling in her thigh to subside before applying a full cast on her leg, so currently, she only has a half-cast on the outer side of her right leg, wrapped in gauze.
After returning home, she is lying flat and slightly elevating her right leg, constantly complaining of pain.
When changing her diaper, she mentioned that sleeping on her left side alleviates the pain.
However, she has a habitual tendency to flex her leg, which means that part of the upper half of the half-cast does not completely conform to her thigh, and this position causes her right leg to be supported only by the gauze attached to the cast.
Could this position lead to a displacement of the fracture? Should we encourage her to sleep on her right side to align her thigh with the shape of the cast? She is over a hundred years old and usually has issues with leg edema; should we frequently massage her calf muscles now? Thank you.

Si Jia, 40~49 year old female. Ask Date: 2016/04/17

Dr. Shi Guozheng reply Orthopedics

A half cast is called a plaster splint, which is only intended for temporary stabilization.
It is important to ensure that the foot fits snugly against the splint.
If there is swelling in the leg, the leg can be elevated slightly to help reduce the swelling.

Reply Date: 2016/04/17

More Info

Caring for elderly patients with femoral fractures, especially in cases where the patient is over 100 years old, requires a careful and compassionate approach. Given your grandmother's situation, there are several key considerations to keep in mind to ensure her comfort and promote healing.

1. Pain Management
First and foremost, managing pain is crucial. Since your grandmother is experiencing significant discomfort, it’s essential to communicate with her healthcare provider about her pain levels. They may recommend medications such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) to help alleviate her pain. If her pain is severe, stronger medications, including opioids, may be necessary, but these should be used cautiously due to the risk of side effects, especially in elderly patients.

2. Positioning and Mobility
You mentioned that your grandmother finds it more comfortable to sleep on her left side. This is an important observation. While it’s generally advisable to keep the affected leg in a stable position to prevent displacement of the fracture, comfort is also key. If she is more comfortable on her left side, you might consider allowing her to do so, provided that it does not compromise the alignment of the fracture.
However, it is crucial to ensure that her leg is adequately supported and not hanging or putting pressure on the fracture site. You might want to use pillows to support her leg and maintain proper alignment with the cast. If she is inclined to bend her knee, it may be beneficial to gently remind her to keep her leg straight, as bending could lead to complications.

3. Cast Care
Since your grandmother currently has a partial cast, it’s important to monitor the cast for any signs of complications, such as increased swelling, discoloration, or foul odors, which could indicate infection. Ensure that the cast is not too tight and that there is adequate circulation to her toes. If you notice any changes, contact her healthcare provider immediately.

4. Preventing Complications
Elderly patients are at risk for complications such as deep vein thrombosis (DVT) due to immobility. To mitigate this risk, consider gentle range-of-motion exercises for her unaffected leg and encourage her to move her toes and foot on the affected side if tolerated. Additionally, elevating her leg can help reduce swelling.

5. Nutrition and Hydration
Proper nutrition is vital for healing. Ensure that your grandmother is consuming a balanced diet rich in calcium and vitamin D to support bone health. Staying hydrated is also important, especially if she is experiencing leg swelling.

6. Skin Care and Hygiene
With her being bedridden, it’s essential to maintain good hygiene to prevent skin breakdown. Regularly check her skin, especially around the cast and on pressure points, and consider using moisture barriers to protect her skin. When changing her diaper, be gentle and ensure she is clean and dry to prevent skin irritation.

7. Physical Therapy and Rehabilitation
Once her swelling decreases and her doctor approves, physical therapy may be beneficial. A physical therapist can provide exercises tailored to her condition, helping her regain strength and mobility safely.

8. Emotional Support
Lastly, don’t underestimate the emotional impact of her injury. Being bedridden can lead to feelings of isolation or depression, especially in elderly patients. Regularly engage with her, provide companionship, and encourage her to express her feelings about her situation.

In summary, caring for your grandmother involves a multifaceted approach that prioritizes pain management, proper positioning, cast care, nutrition, and emotional support. Always keep an open line of communication with her healthcare team to ensure that her care plan is adjusted as needed based on her progress and comfort levels.

Similar Q&A

Caring for Elderly Hip Fracture Patients: Home Care Tips and Considerations

Hello Doctor, last Friday (the 28th), my grandmother fell and fractured her hip. The doctor recommended surgery, but considering her advanced age and chronic illnesses, the family decided against it due to concerns about anesthesia risks. I would like to ask what we should pay at...

Dr. Shi Guozheng reply Orthopedics
The preferred treatment for fractures near the hip joint is surgical intervention. In older adults, as long as anesthesia is managed carefully and the surgery is performed, most patients can recover to a state similar to that before the fracture. Therefore, it is best to choose s...

Rehabilitation Strategies for Elderly Patients with Osteoporosis

Hello, doctor. My grandmother is currently 93 years old and has osteoporosis. Last year, she underwent a vertebroplasty, but due to unsatisfactory results, she can only lie in bed now and is unable to get up, although she can still turn herself. However, there are some issues: ...

Dr. Xu Zhenrong reply Rehabilitation
Hello, Li Li's online friend: Based on your description, your grandmother has osteoporosis and has been bedridden for a long time. Regarding osteoporosis, it is generally understood that bone density begins to gradually decline after the age of 35, with a significant loss oc...

Managing Complications After Hip Fracture Surgery in Elderly Patients

My mother is 90 years old and suffered a greater trochanter fracture due to a fall. After surgery, her leg became swollen like an elephant's leg. Subsequently, she received treatment from a vascular specialist to remove blood clots, which helped reduce the swelling in her th...

Dr. Wang Shouji reply Orthopedics
Hello: It is not uncommon for osteoporosis to cause the displacement of metal pins clinically. If the fracture reduction is acceptable, some cases can be assisted with plaster casting. However, if the pattern of bone displacement is unacceptable, it is necessary to re-lay the pat...

Essential Care Tips for Managing Fracture Patients Effectively

How to care for a patient with a fracture?

Dr. Shi Qiming reply Orthopedics
To begin with, it is essential to assess the patient's mobility. If the patient is unable to move due to a fracture and requires bed rest, rehabilitation should be conducted in bed to prevent joint stiffness and muscle atrophy, typically with assistance for joint activities....