Managing Complications After Hip Fracture Surgery in Elderly Patients

Q: Managing Complications After Hip Fracture Surgery in Elderly Patients

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

The steel pins have shifted due to fractures caused by osteoporosis?

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 thigh.
A few days ago, during a follow-up visit, an X-ray revealed that the screw had shifted.
What should we do to help my mother stand up again? Thank you very much for your assistance.

Lin Jin-zhi, 50~59 year old female. Ask Date: 2017/04/19

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 patient flat and enhance fixation.
Weight-bearing can only be considered once the fracture has healed.
Thank you.

Reply Date: 2017/04/19

More Info

Managing complications after hip fracture surgery in elderly patients can be quite challenging, especially in cases like your mother's, where there are additional complications such as swelling and hardware failure. Here’s a comprehensive overview of what to expect and how to manage these situations effectively.

Understanding the Complications
1. Swelling and Hematoma Formation: After hip fracture surgery, it is not uncommon for patients to experience significant swelling, often referred to as "elephant leg." This can be due to fluid accumulation or hematoma (a localized collection of blood outside of blood vessels). In elderly patients, this can be exacerbated by factors such as immobility, vascular health, and the body's ability to heal.

2. Hardware Issues: The fact that the screws or pins have shifted or "run away" is a serious concern. This can lead to instability in the fracture site and may require additional surgical intervention. It is crucial to monitor for signs of pain, increased swelling, or changes in mobility, as these could indicate complications.

Steps to Take
1. Follow-Up with Orthopedic Surgeon: The first and most important step is to ensure that your mother is evaluated by her orthopedic surgeon as soon as possible. They will assess the situation through physical examination and imaging studies (like X-rays) to determine the extent of the hardware failure and the best course of action.

2. Physical Therapy: Once cleared by the surgeon, engaging a physical therapist can be beneficial. They can provide tailored exercises to improve strength, balance, and mobility. This is crucial for regaining the ability to stand and walk again.

3. Pain Management: Effective pain management is essential for recovery. Ensure that your mother is on an appropriate pain management regimen, which may include medications prescribed by her healthcare provider. Managing pain effectively can encourage participation in physical therapy and daily activities.

4. Nutritional Support: Adequate nutrition plays a vital role in recovery. Ensure that your mother is receiving a balanced diet rich in protein, vitamins, and minerals, particularly calcium and vitamin D, which are essential for bone health. If she has difficulty eating, consider consulting a nutritionist for advice on supplements or meal plans.

5. Monitoring for Complications: Keep a close eye on her surgical site for signs of infection (such as increased redness, warmth, or discharge) and monitor her overall health. If she experiences fever, increased pain, or any other concerning symptoms, contact her healthcare provider immediately.

6. Mobility Aids: Depending on her condition, using mobility aids such as walkers or canes can help her regain independence while ensuring safety. Occupational therapists can also provide recommendations for home modifications to prevent falls.

7. Emotional Support: Recovery from surgery and dealing with complications can be emotionally taxing. Providing emotional support and encouragement can help your mother cope with the challenges of recovery.

Conclusion
In summary, managing complications after hip fracture surgery in elderly patients requires a multifaceted approach involving medical follow-up, physical therapy, pain management, nutritional support, and emotional encouragement. It is essential to maintain open communication with healthcare providers to ensure that your mother receives the best possible care. With appropriate interventions and support, many elderly patients can regain their mobility and improve their quality of life after such surgeries.

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