Fractured neck of femur

Joyce and the Hip fracture

Once upon a time, there was a lady called Joyce. Joyce was 70 years old. She had always been active until she had a heart attack two years ago following the death of her husband. She has lived alone since her husband passed away. Her son and daughter live nearby and take her shopping. She holds on to her daughter Ann when she walks around the shops.  Sometimes she has to sit down when she gets tired.

Every week Joyce takes the bins out on a Wednesday. This week Joyce decided to brave the rain and take the bin out. She didn’t want to miss the bin van, so she decided to take the bin out. She managed to get the bin to the side of the road, but she slipped on the wet pavement while turning to get inside.

She was so upset that she fell and shouted out for help.  Luckily her neighbour Cedric was getting ready for work and heard her screaming. He immediately went to her aid and tried to help her up but she couldn’t stand.

He called for an ambulance and kept her warm and dry while she waited for the ambulance. When the paramedics arrived, they assessed her and transferred her into the ambulance.  It was only 15 minutes to the nearest hospital, but Joyce could feel every bump in the road on her way to the hospital.

Hospital

When she arrived at the hospital, the triage nurse saw her and assessed her. The triage nurse heard that she couldn’t walk after falling over and was worried that she may have a hip fracture. Joyce was immediately sent for an x-ray. The radiographer took two pictures of her hip, one from the front and the other from the side.  Joyce was then returned to the accident and emergency department. While waiting in her cubicle, she could overhear the triage nurse on the phone with another Doctor; this turned out to be the Orthopaedic Doctor.

Ten minutes later, the Orthopaedic Doctor, Dr. Zara arrived. She was very friendly and thorough. She asked lots of questions that Joyce hadn’t thought about, like

“ How do you get around? Do you use a stick? How did you fall? Did you bang your head? How many pillows do you sleep with? Are you on any blood thinning medication? What type of house do you live in? Is there a toilet downstairs?

While Dr. Zara was talking to Joyce, the nurse came and took blood and sent it to the laboratory to be analysed. The nurse ensured Joyce had painkillers and said he would give an injection to help with the pain.

Dr. Zara showed Joyce the X-ray and explained that Joyce had a Hip fracture, also known as a Femoral neck fracture.  

She said that these were very common in patients of Joyce’s age. She explained that as you get older, your bones can become less dense due to osteoporosis. When you fall your bones are more likely to break compared to someone younger. She also said that these injuries can occur in younger people but usually, this as a result of higher energy trauma such as car accidents.

Joyce remembered that her friend Ann had a Hip fracture and had never quite been the same since. She was worried as her Aunt Dorothy, who had dementia for a long time, had died 20 years ago after breaking her hip.

Dr. Zara explained that Joyce was right to be concerned as these were severe injuries and could be a pre-terminal event, as in the case of her Aunt Dorothy. Dr. Zara explained that Medicine had changed a lot since those days, and there was an emphasis on trying to get her back walking as soon as possible rather than the old days when patients with hip fractures used to stay on the wards in traction for weeks developing pressure sores, chest infections, urine infections as well as clots in their legs and lungs. Dr. Zara explained that although things had improved, 3 out of 10 people are likely to die within a year following this injury. On the other hand, 7 out of 10 people survived, which Dr. Zara said was quite good odds considering the number of other medical problems patients with this injury usually have.

Joyce wasn’t sure whether it was the painkillers working or the explanation from Dr. Zara, but she now felt a bit less anxious about the injury and was ready to ask Dr. Zara some questions. She wanted to know what would happen to her and suddenly remembered that her son Jim always comes over with the kids on Wednesday evening for dinner and would be expecting to see her. She wondered whether anyone had told him about what had happened to her.

Dr. Zara reassured her that she would phone her son to let him know once she had explained more about the injury and treatment options.

Dr. Zara explained that Hip fractures or Neck of femur fractures were important because they can disrupt the blood supply to the femoral head.

She explained that the hip joint was like a ball in a socket; if the ball didn’t receive nutrients through the blood supply, it would not survive. She explained that some hip fractures affected the blood supply, called intracapsular fractures and some didn’t affect the blood supply and were called extracapsular hip fractures. If the blood supply is disrupted, they would need to consider replacing the ball with or without the socket. However, if the blood supply was not affected or there wasn’t much displacement, her hip could be fixed to provide pain relief and enable her to start walking as soon as possible.

She explained that not everyone had operations as some people were not fit enough to be put to sleep, have an anaesthetic, or choose not to have surgery. Dr. Zara was clear that most people had an operation and explained the risks and benefits of Hip fracture Surgery.

Joyce decided that she wanted to have surgery and asked when this was likely to take place. Dr. Zara explained that it would be done as soon as possible but not overnight, so Joyce would need to be kept “nil by mouth” from midnight until the team sees her in the morning and assesses her suitability for surgery.

Joyce thanked Dr. Zara for the information she had given her, and Dr. Zara thanked Joyce for taking the time to answer her questions.

Later on, Joyce was transferred from the accident and emergency department to the Orthopaedic ward, where Jim came to visit her. Jim had been apprehensive about his mother as she had not answered the door when he arrived with the kids for dinner. He was grateful for the phone call from Dr. Zara, explaining the seriousness of the situation and reassuring him that his Mum was receiving the best care.

Overnight Joyce could not sleep as there was a lot of noise in the ward from machines beeping and confused patients.

Ward

The following morning Joyce was woken by a team of Doctors, Nurses and Therapists who had finished discussing Joyce’s injury at the Trauma meeting. In the Trauma meeting, Dr. Zara presented the story of Joyce’s injury and the circumstances in which it occurred. She explained the findings on the x-ray and what she had told Joyce and Jim. The Consultant, Mr. Black, introduced himself to Joyce and reiterated the options for treatment. He divided this into operative or non-operative, then fixation versus replacement. He underlined the risks and benefits of each treatment and confirmed that Joyce fully understood this. Then between Joyce and Mr. Black, a decision was made for Joyce to have a half-hip replacement. Mr. Black and the rest of the team left the ward just as Dr. Garden, the anaesthetist, arrived to see Joyce.

Dr. Garden asked Joyce questions about her general health, asked her to open her mouth and explained the options of anaesthetic that she could have to get her through the surgery successfully and without pain.

Next stop...theatre, operation steps etc..👇