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Video: What To Do If An Older Person Has A Hip Fracture
What to do if an older person has a hip fracture
Hip fracture is one of the most common and dangerous injuries in old age. The cause of the fracture is usually age-related osteoporosis. There are many types of these injuries, but the symptoms and care are the same. The most common questions that arise in the families of such patients were answered by Sergei Novikov, a traumatologist at Moscow City Clinical Hospital No. 17.
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Hip fracture is one of the most common and dangerous injuries in old age. The cause of the fracture is usually age-related osteoporosis, due to which the bones become fragile, and even unsuccessful movement can become the reason. There are many types of these injuries, but the symptoms and care are generally the same. The most common questions that arise from the relatives of such patients were answered by Sergei Novikov, a traumatologist at Moscow City Clinical Hospital No. 17.
How is hip fracture treated?
Such injuries are very dangerous in their complications. Therefore, the patient should be taken to the traumatology department as soon as possible, where he should be operated on as soon as possible. Today, endoprosthetics (replacement of a broken joint with an artificial one) for patients with a hip fracture in hospitals in the capital is carried out free of charge under the compulsory medical insurance policy. And age is not a contraindication here: our oldest patient was under 90 years old. The joints differ in the principle of planting - it can be cement (more often in the elderly) or cementless. Rehabilitation after surgery is the same in both situations.
How long does the operation take, under what anesthesia? How large are the incisions?
The operation is performed under spinal epidural anesthesia. A needle is punctured into the spinal space at the level of the lower thoracic or upper lumbar vertebrae and a catheter is inserted. It is fixed on the patient's back and shoulder. During the operation, the patient receives anesthetic through the catheter. The operation takes an hour and a half. All this time, the patient lies on a healthy side. The incision required for endoprosthetics is only 10-12 cm, after the operation it is sutured with a cosmetic suture.
What is the most important thing in caring for a hip replacement patient ?
For 90 days after the operation, it is important to observe safety precautions so that the patient does not dislocate the operated joint. There is a rule of 90 degrees: such leg movements are prohibited, in which the angle between the body and the hip is less than a straight line. A person can lie in bed both on his back and on his healthy side, but in order not to dislocate the joint, a roller must be placed between the legs. You can use a large, thick pillow to keep your legs from closing.
The patient can sit with the leg extended forward, because in this case the angle is greater than 90 degrees. It is also necessary to limit turns with the operated leg inward or outward. Look at the foot, imagine that it is inscribed on the dial. When the toes are up, the foot is looking at 12 o'clock. So, you cannot translate it to 3 o'clock and to 9, that is, you must avoid rotation with the femur. After 90 days, these movements will be possible and completely safe.
On what day after the operation is it time for the patient to "learn" to walk?
The patient is put in bed on the first day after the operation, and the patient is raised and put on his feet with support on a walker - on the second. This recommendation is respected regardless of age, which can be very respectable. The sooner the patient gets to his feet, the less likely he is to get pressure sores and pneumonia. How fast to activate leg work and increase the range of motion in the operated joint should be suggested by the doctor. The usual recommendation is to walk for 2 months with a walker or with canadian crutches, which provide support under the elbows and do not rub the armpits. Then you can try walking with a cane.
How to help the operated person to cope with pain, swelling, hematoma?
The pain is relieved by the drugs prescribed by the doctor. Immediately after the operation, ice, wrapped in a towel and applied to the joint site, helps. Recently, special adhesive tape dressings - tapes are often used. They not only play the role of a fixation and compression bandage, but also activate blood and lymph flow at the site of attachment. Massage will help with edema. You can do it yourself - with smooth painless movements from the toes towards the center of the patient's body, as if driving the swelling up.
How to avoid blood clots in blood vessels?
Usually, for a month after the operation, the patient is prescribed drugs that prevent the formation of blood clots - anticoagulants in tablets. It is not necessary to control blood clotting by special studies. It is necessary to wear type 2 compression garments or bandage the legs (both sick and healthy) with elastic bandages for two months after the operation. It is supposed to put on underwear or bandage your legs in the morning. The person himself cannot cope without outside help, otherwise he will have to break the rule of 90 degrees. At first, the patient even sleeps in compression underwear. You can refuse it later. If swelling forms on the leg, it becomes cold, a violation of the blood supply can be suspected. And here you should urgently show the patient to the doctor.
After such an injury, a person cannot put on socks himself, or pick up an object from the floor. How can these problems be solved?
A special sock wearer can be purchased at the pharmacy or ordered online. This is such a plastic cone on which the sock is pulled. A man throws a cone (ropes are attached to it) on the floor, puts his foot into the cone - and immediately puts on a sock. Shoes should not be with laces, but with Velcro, zippers. There is a simple trick of lifting objects from the floor while sitting. Sit on a chair or stool so that the sore joint hangs down, and, bending over, take the sore leg back. In this case, the angle in the hip joint remains correct, and the hand takes out the object. But older people are better off exercising to do all of these in your presence.
Is it necessary to change something in the apartment where the person will return after the operation?
The bed should be raised, because sitting and lying on a low bed is contraindicated. You don't have to buy new furniture, just put bricks or tomes of encyclopedias under the legs of the bed. Or buy an extra thick mattress for your bed. A special plastic nozzle is installed on the toilet, which can be found in a pharmacy or on the Internet. It raises the seat level by 7 cm. It comes with 3 types of attachments, so the nozzle will fit any type of toilet.
It is easy to move the patient into the bathtub using a special seat or an ordinary board placed on the sides, which will allow not to make an inadmissible movement of the sore leg. Or you can just put the person on the edge of the bathtub and help him to throw the first healthy, and then the operated leg, making sure that he bends back a little and does not break the 90-degree rule. The bathtub must have a rubber anti-slip mat and handrail.
How to transport the operated patient?
It is not necessary to call an ambulance for this or order a special transport. You can take a person home in an ordinary car, placing him in the front passenger seat of the car. But first you need to recline the chair deep enough.
What mistakes should be avoided when caring for an operated relative?
Do not be too reinsured, give a person more independence in movements, even if he is very old. It is clear that the relatives are afraid that he would fall again. And to prevent this from happening again, a complete health examination should be carried out. The loss of balance was probably due to dizziness caused by high blood pressure, an irregular heart rhythm, and a problem with the cerebellum. Properly selected drugs will reduce the risk of falling.
By the way, according to medical statistics, after 55 years, ordinary healthy people fall 3 times a year. It makes sense to develop a safety strategy, for example, to follow the example of elderly Europeans and those with joint problems. They move along the streets with walkers and rollators (three- or four-wheeled trolleys with a locking brake). Such simple things greatly reduce the risk of another fall.
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