Hip Fracture

Postoperative management (of hip fracture patients) requires multidisciplinary coordination, with the combined goal of returning the patient to prefracture status and back to independent living. A large number of patients lose independence and end up being institutionalized after hip fracture because of general disability and loss of ambulation.

Functional recovery after hip fracture can be variable. Only 40 to 60 percent of patients recover their full prefracture ambulatory function, and only 25 to 35 percent regain their full independence in activities of daily living prior to fracture. Factors contributing to these low rates include older age, cognitive impairment, and few outside social contacts.

Early discussion with patients and their families is needed so that everyone is well versed in the intended rehabilitation goals. This is especially important for patients returning home, as structural adjustments may be needed to the house, such as the installation of handrails and grab rails or moving the patient to a single level accommodation. Other home support systems may also need to be implemented. Occupational therapy services and social services can be very valuable. With respect to physiotherapy, the goal is to mobilize patients quickly, and the surgeon needs to make the decision on their weight-bearing status. Medications to prevent thromboembolic disease (blood clots) are required.