Mom Fell And Broke Her Hip – Now What?!

By Dr. Maria Ver

In 2016, I wrote a Hawaii Filipino Chronicle article about falls being the number one killer in Hawaii’s older population.

As the previous Trauma Medical Director of my hospital, Hawaii’s trend of falls being the number one type of trauma remains. With nearly 21,000 emergency room visits and over 2700 hospitalizations yearly, falls are the leading cause of non-fatal injuries in the state, and nationwide.

Hawaii averages about 114 fatalities from falls yearly. Most of the falls are “ground-level falls,” and over 70% of these falls occur at home. Hawaii hospital charges for falls cost $100 million annually, and in the US, healthcare costs relating to falls surpass $50 billion annually.

The majority of those falling is our kupuna 65 years and older, with age increasing the associated risks and complications. In the US, over 300,000 older people are hospitalized with hip fractures yearly, of which 95% are caused by falling, usually sideways.

The top three injuries resulting from falls that I see in my trauma center are head bleeds, hip fractures, and wounds, all of which are consistent with other Hawaii trauma centers. For older patients with traumatic brain injuries, over 70% of deaths and 80% of hospitalizations are caused by falls.

As a trauma surgeon, it is routine for me to evaluate and take care of the trauma patients who come to the Emergency Room. Depending on the types of injury, I then consult the appropriate specialist who would contribute to the overall treatment plan.

Despite all the medical training, it is always difficult when the one who is injured is a member of your own family.

Last summer, my moth- er was at home and had a ground-level fall backwards after tripping over my dog. When she called my phone, she was crying in extreme pain and stated she could not get up from the floor.

My mother is in her mid60s, appears much younger than her age, and was very active otherwise. I rushed from work to the house worried, not just about her, but also about my baby who was now unattended since Mom was immobile.

When I arrived, my Mom was on the floor in obvious pain. When I examined her, I already had a very high suspicion of a hip fracture, which would be a surprise to me since I didn’t think that this “could happen to my Mom.” hip arthroplasty). The hardware used is made of titanium; a special metal that the body adapts well.

My colleague and I were unable to lift my Mom due to her severe pain. Therefore, we called 911 and the ambulance came several minutes later. Before loading her to the stretcher, the paramedics had to give her strong IV pain medications to help make transport comfortable and safer.

She was taken to the nearest trauma hospital and was evaluated in the emergency room. The workup by the Emergency doctor and on-call Trauma surgeon confirmed a right hip fracture. Fortunately, that’s the only injury that she had.

The on-call Orthopedic surgeon was consulted and recommended urgent hip repair surgery. Therefore, my Mom was admitted to the hospital under the Hospitalist (inpatient medical doctor) service to prep her for surgery the next morning.

Recovery from a hip fracture may be difficult and many people lose some of their independence. Hip fractures are the most expensive fracture to treat on a per-person basis.

The hip is comprised of the femur bone in the thigh that connects to the pelvis with a ball-in-socket joint (femoral head into the pelvis acetabulum). The nature of the fall affects the type of breaks in the bone. The location of the break affects healing potential. The most commonly fractured area is the femoral neck, which connects the femur shaft to the head.

Treatment options for hip fractures are basically whether to fix them surgically or not.

Non-operative management may be recommended for those with mild fractures where the hip joint is still stable and therefore causing minimal pain. Also, if the patient has conditions that make them too high of a risk for surgery, then the risks can outweigh the benefits.

If the patient is able to walk prior to the fracture and no operation is planned, then the physical therapist gets involved early to help mobilize and get the person walking again. The Hospitalist will prescribe a pain control regimen to help make the pain manageable.

Most Orthopedic surgeons argue that all hip fractures are operative. They operate to repair these fractures, even on the elderly patient, as the immobility itself has high complications.

These complications include pneumonia from breathing shallow, urinary tract infections from holding in urine, and pressure ulcers from being bedbound. The infections themselves, especially in an older patient, can be deadly. Immobility also can result in blood clots and general deconditioning.

It is alarming that the mortality rate of a hip fracture is 30% within 90 days. This percentage increases if we wait over 48 hours for surgery. Therefore, the benefits of operating urgently outweigh the risks.

Fixing the hip fracture stabilizes the joint for weight-bearing, decreases the pain, and allows for an earlier return to standing and walking. Surgery options include ORIF (Open Reduction Internal Fixation using rods, plates, and screws), screw fixation, and partial or full hip replacement (hemiarthroplasty/total

The average operative time for a hip repair surgery is two to four hours, performed under general or spinal anesthesia. Once the surgeon clears the patient to walk (usually in one to two days, but as early as the same day), then the physical therapists start working with the patient.

In my center, hip fracture surgery accounts for 20% of all orthopedic surgeries. The average time in the hospital for a hip fracture patient is about four days. The physical therapists and occupational therapists (PT&OT) will assess if the patient is safe and ready to go home. The hospital Case Management team gets involved by helping families get ready for discharge home versus to another facility.

If the patient is safe and able to go home and has proper social support for help, then the case manager will set up PT&OT services to come to the house (home health) or set up visits at an outpatient facility.

My Mom had ORIF hip surgery. She stayed longer in the hospital due to intolerance to the strong pain medications, which also limited

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