Chapter 7: Hip Fractures: Treatment and Prevention 2 CC Hours
By: Katherine Rush, PT Learning objectives
Discuss the reasons for a total hip replacement, what challenges this procedure might present and the unique implications of the anterior versus the posterior approach. Discuss the progression of physical therapy to maximize progression to each patient’s either prior level, or maximum level, of functioning. Relate practical and effective preventative measures that patients can take to prevent future falls.
After completing this course, the learner will be able to: Distinguish the difference between the three major types of hip fractures, their characteristics and the indications for treatment of each. Summarize the similarities and differences between the physical strategies for rehabilitation for the surgical candidate, versus the non-surgical candidate. Discuss the issues associated with each. Identify the different approaches to hip surgery; discuss the advantages, disadvantages and the treatment strategies and rehabilitation outcomes for each of these surgeries. Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gen- der identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can mani- fest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assump- tions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can
adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and aware- ness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Addi- tionally, implementing policies and procedures prioritizing equi- table treatment for all patients can play a pivotal role in reduc- ing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treat- ment regardless of their background or characteristics.
INTRODUCTION
A thoughtfully designed physical therapy program is vital for the treatment, as well as the prevention, of hip fractures. The physi - cal therapist is an essential partner to assist patients in preserving, improving and maintaining the current levels of functioning within their daily lives. This course will provide an overview on the three main types of hip fractures, the differences between the approach- es to surgical and non-surgical candidates for physical therapy, and prevention techniques that the physical therapist can share which will ensure a patient is knowledgeable about how to prevent future fall occurrences. either by a compression hip screw (a screw fixed to the outer side of the bone with a lag screw directed into the neck and head of the hip) or with an intramedullary nail (a nail set into the marrow canal of the bone with a lag screw directed into the head and neck of the hip). The outcomes of these two treatments are virtually the same and will depend on which surgeon is performing the surgery. ● Subtrochanteric fracture : Refers to a fracture below the lesser trochanter, generally within about 2.5 inches. It is of- ten repaired with an intramedullary nail and various types of screws (depending on the location and extent of damage) to stabilize the nail (The American Academy of Orthopedic Sur- geons, 2009).
A hip fracture is a break in the upper quarter of the femur, or the thigh bone. These types of fractures occur most commonly from falls, although some conditions like cancer, osteoporosis or stress injuries can weaken bones and make them more susceptible to breaking. Other factors, including multiple medications, dimin- ished vision, as well as balance problems can also make older individuals more likely to fall. Each year, over 250,000 people are hospitalized for hip fractures, and some of these individuals will never fully regain their prior level of function: they may require assistance to walk, and a few will even need to go to a nursing home (CDC, 2015). It is also likely that a large percentage of them will die. Types of hip fractures There are three major types of hip fracture: Intracapsular fracture, intertrochanteric fracture, and subtrochanteric fracture. ● Intracapsular fracture : Occurs at the level of the neck and head of the femur. As the name suggests, this fracture occurs within the capsule that surrounds the hip and can often impair circulation to the head of the femur, causing avascular necro- sis. While these fractures can often be repaired with a pin or a screw, some surgeons will instead decide to replace the head of the femur (hemiarthroplasty) or will replace both the head of the femur and the acetabulum with a total hip replacement. A complete hip replacement can help prevent the arthritis that often results from the avascular necrosis. ● Intertrochanteric fracture : Occurs between the neck of the femur and the lesser trochanter. This fracture can be repaired PT for the nonsurgical candidate Only a very small percentage of patients with hip fractures are not considered surgical candidates. Patients not considered sur- gical candidates are typically those with severe dementia, poor life expectancy, were non-ambulatory prior to the hip fracture, or
who have one of the above conditions and are relatively comfort- able. The goal in these cases is not necessarily to improve mobil- ity; rather, it is to improve patient comfort. PT is likely to consist of passive range of motion (PROM) of the other extremities, and
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