Prevent complications of hip fracture and don’t let it become the last straw that breaks the camel’s back!

Author: Kong Xiangyan, deputy chief nurse, Peking University People's Hospital

Reviewer: Li Jun, deputy chief physician, Peking University First Hospital

In clinical practice, hip fracture is often referred to as the last fracture in the elderly.

This is because the elderly are not in good health and may suffer from multiple diseases. Once a hip fracture occurs, a series of complications are likely to occur, such as lung infection, deep vein thrombosis in the lower limbs, pressure injury, etc.

Because these complications can result in a particularly high mortality rate among patients, a hip fracture is likely to be the straw that breaks the camel's back.

How to prevent these complications and reduce the mortality rate of patients? Let's learn together.

1. How to prevent lung infection after hip fracture?

After a hip fracture, patients often need to stay in bed to rest. Long-term bed rest will lead to a decrease in the patient's respiratory clearance ability, making respiratory secretions difficult to cough up and accumulating in the lungs, causing infection, which is medically known as aspiration pneumonia.

To prevent aspiration pneumonia, we need to start from the following aspects:

First, assess the patient's nutritional status and provide him with a high-protein, crude fiber, and high-vitamin diet to support his physical strength and resistance.

Second, a good indoor environment. For example, a room temperature of 22℃-25℃ and an air humidity of 50%-60% are relatively good. In addition, whether in the hospital or at home, windows should be opened regularly every day for ventilation, so that the indoor air can be relatively fresh.

Third, drink more water, which can dilute the sputum. If the patient can cough up sputum, let the patient cough it out. If the patient cannot cough up sputum, nebulization may be needed to dilute the sputum, which is conducive to the patient's coughing.

Fourth, turn the patient over and pat his back. For example, we can use our hollow palms to pat his back from outside to inside and from bottom to top. The purpose of patting the back is to make the lungs move and help the patient expel phlegm. This is very important.

Fifth, it is also very important to teach patients some methods to practice lung function, such as pursed lip breathing, which is to inhale hard, purse your lips like a whistle after inhaling, and slowly exhale. Generally, it is required to inhale for two seconds and exhale for six seconds, so as to exercise lung function. In addition, for hospitalized patients, the ward will prepare a balloon for the patient to blow up the balloon, so as to practice lung function.

Figure 1 Original copyright image, no permission to reprint

Sixth, maintain good oral hygiene. For patients who can move, let them take the initiative to do oral hygiene. If they cannot do so, they need to do special oral care, such as using saline cotton balls to wipe the patient's mouth, so as not to allow microorganisms to grow in their mouths and cause infection.

Seventh, prevent cross infection. For example, medical staff or family members should not contact patients after catching a cold, or wear a tight mask to prevent cross infection. If the patient's family members are infected, they should also do the same to prevent it.

2. How to prevent deep vein thrombosis in the lower limbs after hip fracture?

Long-term bed rest is not only prone to aspiration pneumonia, but also prone to deep vein thrombosis in the lower extremities. If the thrombus breaks off and flows along the blood, it will cause corresponding embolic complications. If it enters the lungs, it will cause pulmonary embolism, which may be life-threatening in severe cases. Therefore, the prevention of deep vein thrombosis in the lower extremities is very important.

There are many ways to prevent deep vein thrombosis in the lower limbs, such as basic prevention, physical prevention, and drug prevention.

1. Basic prevention:

When the patient is admitted to the hospital, he should be told to quit smoking and drinking, and drink more water to dilute the blood and prevent blood congestion and viscosity. In addition, the affected limb should be raised, generally slightly higher than the heart.

Encourage patients to do some exercises, such as ankle dorsiflexion and plantar flexion, and ankle pump training, to exercise the calf muscles. Also teach patients the isometric contraction of the quadriceps femoris, which means that patients should straighten their legs and stretch their thighs. After stretching their thighs, they will feel that their thighs are particularly hard, which is the isometric contraction of the quadriceps femoris. Through these exercises, patients can increase their bed activities and blood circulation to reduce the occurrence of thrombosis.

2. Physical prevention:

With the help of some instruments, such as plantar venous pumps, intermittent pneumatic pressurization devices, and some anti-thrombotic gradient pressure stockings, these three types are more commonly used in clinical practice. They use the human body's ankle pump principle to increase blood circulation, which can prevent blood congestion and retention and avoid thrombosis.

3. Drug prevention:

Aspirin, vitamin K antagonists, low molecular weight heparin, coagulation factor X inhibitors. During medication, there are some issues to pay attention to. Observe his bleeding at any time to avoid bleeding, and monitor coagulation indicators when necessary.

Figure 2 Original copyright image, no permission to reprint

3. How to prevent pressure injuries after hip fracture?

After the patient is hospitalized, the first thing to do is to perform local decompression according to different situations.

For example, the patient should be allowed to move the parts that can be moved; the parts that cannot be moved should be helped to move, such as turning over. While turning over, check the parts that were just under pressure, for example, if he was lying flat, check his sacrum and coccyx, and whether the skin of the heels is under pressure.

If 20-30 minutes after turning the patient over, you find that the part that was just under pressure is still red and has not faded, you should shorten the interval between turning the patient over, and the maximum interval should not exceed two hours. You can also use some special equipment, such as anti-pressure sore air cushions, turning beds, soft pillows, or silicone pads, to help prevent pressure sores.

Take good care of the skin, such as giving the patient a bath frequently to keep the body dry, and avoid using irritating bath gels. Keep the sheets wrinkle-free and free of debris that may hit the patient. When turning over, make sure the patient's clothes are straight and wrinkle-free.

For bony protrusions, such as the sacrum, heel, medial malleolus, lateral malleolus, and distal radius of the human body, they need to be protected with some devices, such as pressure-relieving patches.

If the patient has a urinary catheter or drainage tube, the tube should be placed on a raised platform to prevent it from causing damage to the patient's skin. The tubes should be properly cared for and secured.

For patients with incontinence, good incontinence care is needed, because incontinence can easily cause incontinence dermatitis and damage the skin. Therefore, for patients with incontinence, first wipe the patient's skin clean with clean water and apply a light layer of skin protection film. This way, if there is further immersion of urine and feces, it will not irritate the skin.

In addition, it is also necessary to assess the patient's nutritional status to ensure that he has resistance and good skin elasticity. This is a long-term care and prevention process.