Dad is in the hospital with a hip fracture. This is a first for our family. What can we do to help him maintain his independent lifestyle once he’s home?

April 13th — admin

Dad is in the hospital with a hip fracture. This is a first for our family. What can we do to help him maintain his independent lifestyle once he’s home?

Many older adults who survive a hip fracture are left with problems they didn’t have before the fracture. For example, they may have to use a walker or cane to get around. Walking and managing stairs can be major disabilities now. Dressing and undressing can be difficult. And some patients are unable to get back to their regular community or social activities. Recovery can take up to two years.  

Most patients receive physical therapy while in the hospital. But PT after discharge isn’t always ordered or provided. Yet studies show that patients with this injury who have PT after going home are less likely to be rehospitalized. They are also less likely to die from complications of this condition.

The therapist will help the patient regain motion, balance, and strength needed to resume normal activities of daily living. These skills are also needed to get back to regular social activities. Breathing exercises and aerobic conditioning may help prevent problems such as pneumonia that can cause rehospitalization and even death.

Most states in the U.S. now have consumer access or direct access to PTs. This means you can contact the therapist directly without requiring a physician’s referral. The therapist’s evaluation will include screening for conditions that require medical attention.

After a few weeks of PT, many patients can be set up on a supervised home program they can follow on their own. The therapist will also help identify safety concerns in the home environment. Anything you can do to make sure safety feature are installed (e.g., lighting, tub bars) will go a long way to prevent future falls and subsequent fractures. 

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Skylight sign shows how to avoid fracture during hip replacement

November 16th — admin

What is a skylight sign? When the surgeon showed me Dad’s hip X-rays, she said a skylight sign tipped her off to avoid a hip fracture during Dad’s hip replacement operation.

Thinning of the bone allows light coming from the other side to stream through the thin section. This light stream through the bone is called the skylight sign. It can only be seen from the side. The surgeon must use a lateral (from the side) approach to see the skylight sign.

From this angle, the bone is exposed as the muscles are cut away. Using other methods won’t allow the surgeon to check for the skylight sign. Patients with a positive skylight sign are at increased risk for fracture. Fracture can be prevented by changing the surgical technique or size of the implant.

Sometimes reinforcing the bone with wire cables can help prevent fracture during the operation. The cables are placed around the bone. If a fracture occurs during the surgery, the cables can be left in place to help stabilize the bone during recovery and rehab.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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More hip replacements means more hip fractures

August 5th — admin

I’ve been a nurse on the med-surg floor for over 20 years. I think we are seeing more and more hip fractures in patients with a hip replacement. What’s causing this increase in numbers?

Several studies have confirmed your observations: the number of femoral (thigh bone) fractures after total hip replacement (THR) is on the rise. There may be several reasons for this change.

First of all, more people are having THRs. Good results from the surgery has also increased the number of people and types of problems that can be helped by THR.

Third, with more people having THRs, the number of revision operations is increasing, too. Patients who have had a THR 20 years ago are still alive and going strong. Increased physical activity decreases the life of the implant. Many of these patients have revision surgery to replace the first implant. Fractures are more likely and more common after revision surgery.

Finally, implant design may be a factor. A recent study from Sweden pointed out the fact that implants with a straight and short stem are more likely to loosen causing dislocation and/or fracture. Complications such as fracture and implant loosening may be further reduced with continued research and improved implant design features.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Most hip fractures occur in women over 65. Why?

July 15th — admin

I heard that most hip fractures are in women over 65. Can you explain why this happens?

Two major factors account for the number of hip fractures in older adults, especially women over age 65. The first is osteoarthritis of the joints — wear and tear on the joints that seems to be part of the aging process for many adults. The second is osteoporosis (brittle bones), which often occurs as a result of menopause for women. Osteoporosis can also affect men in this age group.

Loss of balance and falls are a major cause of hip fractures. There are many risk factors for falls for both men and women. Muscle weakness and decreased reaction time when the balance is challenged are part of the problem. Medications that cause dizziness or dehydration can also contribute to falls.

Sometimes simple household situations can cause problems. For example slippery floors, throw rugs, animals under foot, or stairs without handrails can lead to falls. Problems with vision and hearing so common in older age can add to the risk. Use of alcohol or other substances is another risk factor.

Doctors, nurses, and physical therapists are working together to teach older adults about the dangers and risks that can lead to falls and hip fractures. Osteoporosis prevention for men and women begins with nutrition and exercise early in life. Staying active and doing specific balance exercises can also make a difference.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Criteria for determining the need for rehab

July 12th — admin

My 87-year old mother fell and broke her hip. She had surgery and she’s still in the hospital. The staff is talking about sending her to rehab. How is this decided?

When it comes to rehab after hip fracture, each hospital has its own algorithm or formula for decision-making. Some of this is based on what services are available. Does the hospital have a rehab unit? Would the patient have to be transferred? How far? Health care coverage (insurance or Medicare) is a factor.

The patient’s status is also very important. Patients which have advanced dementia may not be suitable for rehab. The same is true for someone who was wheelchair bound, weak, and deconditioned before the surgery.

Age is a factor but doesn’t limit patients from receiving services that can help them. For example, studies show patients 85 years old and older are less likely to have a good outcome. But this doesn’t mean that someone in this age range can’t do very well.

It may be best to talk with the hospital social worker assigned to your mother’s case. Find out how they make this decision. The family and family support is a very important part of the discharge planning.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Delay in surgery for hip fracture could be fatal

November 25th — admin

I heard a report that older folks who break a hip on Sunday are more likely to die. Is there some religious significance to this?

The answer to this question lies more in the fact that a fracture on the weekend may not get treated until Monday at the earliest. Often the surgery schedules are full for Monday and the patient must wait until Tuesday.

Surgical delays caused by low staffing on weekends are the real culprit, not the fact that the break occurred on a Sunday. A recent study of over 18,000 patients with hip fracture showed a much higher chance of dying in patients whose surgery was delayed two days or more.

The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. For more information on this subject, visit www.zehrcenter.com.

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