Open Reduction And Internal Fixation Of A Hip Fracture

WHAT YOU SHOULD KNOW:

Open Reduction And Internal Fixation Of A Hip Fracture (Inpatient Care) Care Guide

Open reduction and internal fixation (ORIF) is surgery to fix a broken bone in your hip. A hip fracture is a break in the top of the femur or in the hip socket. The femur is the long bone in your thigh that attaches to your pelvis at the hip joint. During ORIF, the broken parts of your femur will be put back together using metal hardware. You may also need an implant to replace your hip socket.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • You may get an infection or bleed more than expected. Blood vessels, nerves, or muscles may be damaged. Your hip may not heal or work as well as it did before your injury. You may still have pain, a limp when you walk, or need to use a cane or walker.

  • You are also at risk of developing a fat emboli. This is when fat is forced out of the inside of the bone and travels to other parts of your body. It can block blood flow to your lungs, brain, or heart. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.

  • Without surgery, you may continue to have very bad pain. You may continue to bleed if you have broken blood vessels, and this could become life-threatening. Your broken hip may not heal properly and your leg may stay bent. You may not be able to walk or move your hip joint as well as before. You may not be able to walk at all.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Anesthesia: This medicine is given to make you comfortable. You may not feel discomfort, pressure, or pain. An adult will need to drive you home and should stay with you for 24 hours. Ask your caregiver if you can drive or use machinery within 24 hours. Also ask if and when you can drink alcohol or use over-the-counter medicine. You may not want to make important decisions until 24 hours have passed.

  • Medicines:

    • Antibiotics: Antibiotics are given to help prevent infections caused by bacteria during or after your surgery.

    • Blood thinners help prevent blood clots. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise.

    • Heart medicine: You may be given a dose of medicine called a beta blocker. It may prevent heart problems, such as a heart attack, during or after your surgery.

  • Monitoring:

    • Heart monitor: Sticky pads placed on your skin record your heart's electrical activity.

    • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine.

    • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain.

During your surgery:

Your caregiver will make an incision on your hip to see the damaged femur. He will straighten your femur and put the broken pieces of bone together. He may use metal screws, bars, plates, or rods to hold the broken bones tightly together. He may use artificial implants to replace the head of your femur and hip socket. Caregivers may secure the implants using screws or cement. X-rays may be taken during surgery to help caregivers put your hip joint back together. X-rays can also tell caregivers if the devices and implants are in the right places. A drain may be placed to carry blood and other fluids away from your hip joint. Your incision will be closed with stitches or staples and covered with a bandage.

After your surgery:

You will be taken to a recovery room where you can rest until you are fully awake. Caregivers will monitor you closely. When caregivers see that you are okay, you will be moved back to your hospital room. Do not try to get out of bed until your caregiver says it is okay. A bandage will be used to cover your stitches or staples and drain. The bandage will help prevent infection. A caregiver will remove the bandage soon after your surgery to check the area. The drain may be removed a day after your surgery.

  • Activities:

    • Deep breathing and coughing: This will help decrease your risk for a lung infection after surgery.

      • Hold a pillow tightly against your incision when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breaths help open your airways. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.

      • You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece into your mouth and take a slow, deep breath. Let out your breath and cough. Repeat the steps 10 times every hour.

    • Physical therapy: Caregivers may have you do exercises the day of or the day after your surgery. You may also be asked to move yourself between your bed and a chair. On the next day, you may be asked to stand and walk while holding onto bars for support. Later you will walk with a walker or cane, and then without a device, if possible. Caregivers may also teach you exercises to strengthen the muscles around your hip joint and speed up your recovery. Tell your caregiver if you have trouble or pain when you exercise, stand, or walk.

    • Preventing deep vein thrombosis: Deep vein thrombosis (DVT) is a condition in which blood clots form inside your blood vessels. This can happen after a major bone surgery. Ask your caregiver for more information about DVT. The following can help prevent clots from forming:

      • Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots.

      • Exercises: You may be asked to move your legs, stand, and walk soon after surgery. This also helps prevents blood from pooling in your legs and causing clots to form.

      • Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Medicines:

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Pain medicines:

      • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.

      • Pain medicine: You may be given a prescription medicine to decrease pain. Do not wait until the pain is severe before you ask for more medicine.

      • Patient controlled analgesia: You may get pain medicine through an IV or an epidural line attached to a patient controlled analgesia (PCA) pump. Caregivers set the pump to let you give yourself small amounts of pain medicine when you push a button. Your pump may also give you a constant amount of medicine, in addition to the medicine that you give yourself. Let caregivers know if your pain is still bad even with the pain medicine.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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