Philipp N. Streubel, MD, et al.
Current Orthopaedic Practice. September/October 2009. Vol. 20. No. 5. Pp. 482-489
What can be done to reduce the number and severity of complications related to surgery for hip fracture? That’s the focus of this article. It’s clear from other studies that a delay in surgery can make things worse. Even a 24-hour delay increases the risk of death. The longer the delay, the greater the risk of pressure ulcers.
One of the significant factors contributing to delays in surgery is the insistence on cardiac testing before surgery. Treating the heart conditions seems like it makes good sense. But studies show that testing doesn’t really change how these patients are treated – it just delays the surgery they were admitted for in the first place.
A second risk factor for poor outcome after surgery for hip fracture is malnutrition. Decreased bone mass is often linked with poor nutrition. And with an inadequate diet comes weight loss and no fat to protect the bones when a fall occurs. Malnutrition also leads to poor wound healing and an increased risk of those pressure ulcers already mentioned.
What can be done when the patient comes in to the hospital with osteoporosis and a hip fracture? Several studies have showed using intravenous nutritional supplementation followed by vitamins taken by mouth can really make a difference. Nutritional consultation with a specialist is also advised. A nutritional expert can help with the immediate concerns about malnutrition as a risk factor for complications but also set up a plan for home once the patient is discharged. This step is essential in preventing future health problems of all kinds.
Many older adults have bleeding ulcers from taking antiinflammatory drugs for their arthritis. Smoking adds to the risk of GI bleeding. One-third of all patients having hip fracture surgery end up needing a blood transfusion. Proton pump inhibitor (PPI) can be used right after surgery for anyone with risk factors for GI bleeding.
There are other measures that can be taken to decrease postoperative problems after hip fracture repair. These include protective padding over prominences to prevent pressure ulcers, antibiotics to prevent infections, and proper pain management to prevent stress-induced heart problems.
Once the patient leaves the hospital, they face a 2.5-fold risk of another fracture. That’s why it’s important to carry through with a postoperative program to address the problem of the osteoporosis through medications and exercise. The authors suggest developing specialized osteoporosis clinics where patients can receive proper education about this condition.