A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. Nurse Andrew should include which intervention in the postoperative plan of care?
a. Performing passive range-of-motion (ROM) exercises on the client’s legs once each shift
b. Keeping a pillow between the client’s legs at all times
c. Turning the client from side to side every 2 hours
d. Maintaining the client in semi-Fowler’s position
Answer B. After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted.
Passive or active ROM exercises shouldn’t be performed on the affected leg during the postoperative period because this could damage the operative site and cause hip dislocation.
Most clients should be turned to the unaffected side, not from side to side.
After hip pinning, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler’s position should be avoided.
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Surgery Overview:
For a hip fracture, operating is usually the best treatment. Three types of surgery can be performed.
- Hip repair (internal fixation). Hip repair involves stabilizing fractured bones with screws, nails, rods or surgical plates. This type of surgery is usually done in people who have fractures in which the bones can align correctly. This can also be called "implantation of nails in the hip".
- Partial hip arthroplasty (partial hip replacement surgery). In this surgery the upper part of the femur (the head of the hip joint) is replaced with artificial parts made of ceramic or metal. It does not replace the hip cavity.
- Total hip arthroplasty (total hip replacement surgery). In this surgery, all parts of the joint are replaced with artificial metal, ceramic or plastic parts.
Nail implant surgery to repair a hip fracture comprises two main steps:
- Reduction (get the bone to align correctly)
- Internal fixation (stabilize fractured bones)
During surgery to repair a hip fracture, your doctor will make one or two cuts (incisions) over the broken bone in the hip. The bone pieces are put back in the correct position, and fixed in place with pins, screws, nails, rods or metal plates. You may have x-rays to see if the pins and plates are in the right place. The doctor uses stitches or staples to close the incisions. The operation lasts 2 to 4 hours.
Doctors usually use general anesthesia for hip fracture operations, which means that you will be asleep during surgery. But sometimes they use regional anesthesia, which means that you cannot feel the area of the operation and you will feel sleepy but you will be awake. The decision depends on your doctor, your general health and, to some extent, what you prefer.
What to expect after surgery:
Immediately after the operation of a hip fracture, medications will be given to control pain and, perhaps, medications to prevent the formation of blood clots. You may have a urinary catheter so you don't have to get out of bed to urinate. You may also have a compression pump or compression stocking on your leg, which squeezes your leg to keep blood flowing and to help prevent blood clots. And maybe you have a cushion placed between your legs to keep your hip in the right position. It is not unusual to have an upset stomach or feel constipated, so talk to your doctor or nurse if you do not feel well.
Your doctor can teach you to do simple breathing exercises to help prevent lung congestion while your activity level is reduced. You can also learn to move your feet up and down to flex your muscles and keep the blood circulating. And you can start learning to keep your hip in the right position when you move in bed and get out of bed.
Displacement:
It is very important to start moving shortly after the operation. This will speed recovery and reduce complications.
In general, most people get out of bed with help the day of the operation or the next day. Most likely they move him to a chair for a short time. During the following days, you are likely to start doing light exercises and learn to walk with a walker or crutches.
It is likely to remain in the hospital about 2 to 7 days after the operation. They could transfer you to a long-term care facility for rehabilitation before returning home. During rehabilitation, you can get help with daily activities, such as bathing while sitting on a sidewalk. You probably need a walking aid - a walker, a cane or crutches - for several months. And a full recovery can take up to a year.
After the hip operation:
There are many issues to consider after hip surgery. Older adults often need extensive care, including physical therapy and help with cooking, taking medication and personal care. Medications that reduce the risk of blood clot formation and stroke, pulmonary embolism or associated thrombophlebitis are prescribed.
After a hip fracture surgery, your doctor will encourage you to participate in a rehabilitation program. Following a rehabilitation program is very important, because it will speed up your recovery and allow you to return to your daily activities sooner.
Why it is done:
The operation is performed to keep the broken parts of the hip in place so that they can heal faster. Some kinds of fractured bones heal on their own with a cast. However, a fractured hip is not likely to heal well without surgery.
Effectiveness:
The surgery usually works well, but you will have to be patient. Recovering probably takes a long time. And you may never move as well as before.
Surgery is usually the best option after a hip fracture, because it stabilizes the bone so you can move sooner.note1 This helps prevent other problems such as pressure injuries and weakness. Surgery also increases the likelihood that the bone will remain in place so that the fractured leg is not a little shorter than the other after healing.
Risks:
The risks of hip repair surgery can be divided into two groups:
+ Risks of surgery and recovery period, such as:
- Bleeding
- Infection
- Blood clots.
- Delayed wound healing.
- Problems with anesthesia.
+ Long-term risks that may occur, or that may be noticed, between months and years after the operation. Some of these problems can happen with or without surgery, but they are more likely to occur if you don't have surgery. These include:
- Pseudoarthrosis (lack of consolidation). This means that the parts of the bone do not heal together again.
- Fracture around the screws, nails or rods used to repair the bone.
- Difference in leg length. This means that when the fractured leg heals, it is a little shorter than the other leg.
- Problems with the circulation of blood inside the bone, which can cause part of the bone to die (osteonecrosis).
To think:
Reduction (getting the bone aligned correctly) and internal fixation (stabilizing broken bones) are often done in young and active people. Hip arthroplasty is usually done in older adults who do less activity. A long-term study compared older adults who had a hip replacement with others who had their hip repaired. Those who underwent a hip replacement might be more active and less likely to need surgery again. Note2 When deciding which of these methods to use to repair a hip fracture, your surgeon will consider the type of fracture, your age and activity level, and also the possible advantages and disadvantages.
