Identifying risk factors for and preventing hip fractures in elderly patients

AORN Journal, Oct, 1997 by Ellice Mellinger

Reported mortality rates in elderly patients who undergo hip surgery range from 15% to 30% one year after their hip fractures. In malnourished elderly patients, the mortality rate from surgical hip repairs increases to 70% one year after their hip fractures.(24)

Previous fractures. Elderly patients who fracture their hips are at increased risk for subsequent hip fractures, as are middle-aged patients who are in poor health and who experience episodes of dizziness.(25) In one study of 3,898 patients 40 years of age and older with histories of hip fractures, 5 to 10% of their hip fractures were second hip fractures, and 92% of these patients experienced contralateral fractures.(26)

Exceptions. Obese women and women who gain weight after 25 years of age have a decreased risk for hip fractures, which may be explained by greater bone mass in heavier persons, the conversion of adrenal androgen to estrogen in adiopose tissue, and the protective measures of fatty tissue.(27) Women whose mothers had osteoarthritis also may have decreased risk for hip fractures because osteoarthritis may be linked genetically with an increased rigidity of bone, thus making osteoporosis less likely.(28)

TREATMENT OF HIP FRACTURES

Surgical treatment for hip fractures has changed with advances in surgical technology. It is imperative, therefore, that perioperative nurses conduct preoperative risk assessments on elderly patients with hip fractures for optimal surgical outcomes.

History. Hippocrates relied on mechanical aids to reduce displaced fractures.(29) He applied wine-soaked linen reinforced by splints made of sheet lead. The hip and knee were fixed in full extension and left undisturbed for 20 days. In 1845, amputation was the common treatment of choice for femoral fractures, but the mortality rate was more than 60%. Internal fixation of any fracture was not possible until the English surgeon Joseph Lister described and introduced aseptic technique in 1860s.(30)

Hip fractures were difficult to diagnose, and surgical techniques for hip fractures were not possible until the availability and use of lateral x-rays in the 1930s.(31) In 1927, surgeons used ivory to replace the femoral head, and in 1943 metal prostheses for femoral head replacement became available.(32)

Before surgical interventions were possible in the 1930s, patients often died from pneumonia, decubitus ulcers, and pulmonary emboli, and there was an estimated mortality rate of 60% one year postfracture.(33) Today, surgical fixation is the most common treatment of choice for patients with hip fractures because use of internal prosthetic devices allows early postoperative patient ambulation.

Today. Preoperative risk assessments of elderly patients with hip fractures are important because these patients are at high risk for wound infections, fluid volume deficits related to NPO statuses, and skin integrity impairment. One researcher reported a 66% prevalence of pressure ulcer formations among elderly patients admitted with femoral fractures.(34)