Rehabilitation After a Hip Fracture

It was during one such outing that Ruth, 74, fell on loose gravel and fractured her hip.

The injury not only put her at risk for life-threatening complications, including infection and embolism, but it also stripped Ruth of her ability to care for herself and her ailing husband.

As she focuses on her recovery, Ruth has just one thing in mind: To become independent again.

For many older adults who experience a hip fracture, the return to functional independence may be an elusive goal. Within one year of injury, 12 percent to 30 percent of patients die from related complications, and as many as a quarter of those who survive require nursing-home care, due in part or in whole to the fracture.

"When we’re older, we don’t have the reserves to come back from a significant injury. A hip fracture is a very significant injury," said William D. Abraham, M.D., orthopedic surgeon at Tri Rivers. "When people lose the ability to ambulate, their general health takes a turn for the worse as well."

But while the statistics paint one picture of life after a hip fracture, patients like Ruth, who is making progress toward her goal of recovery, are beginning to create another. This one is more hopeful and encouraging.

"Despite having a major injury that disrupts their existence," Dr Abraham said, "many hip-fracture patients may return to a fairly normal, functionally independent life."

The idea of an active and self-reliant post-fracture patient may conflict with the more familiar image of a patient who remains frail and bedridden. With proper acute care, aggressive rehabilitation and fall prevention strategies, the outlook for many hip-fracture patients can be positive.

According to Dr. Abraham, who cares for hip fracture patients, several key factors play a role in recovery. First among them is pre-injury condition.

"Activity level among older adults varies widely," Dr. Abraham said. "A patient who was fit and active before the injury has some important advantages. He or she will probably be more resistant to complications and will regain muscle strength, flexibility and balance more quickly than someone in poor general condition."

A second consideration is the type of injury itself.

Because the hip can fracture in different places, treatment can vary. A patient who requires total joint replacement may be able to bear weight on the affected hip within a few days. Ambulation helps to prevent complications and helps the patient regain strength and balance more quickly.

In contrast, a patient whose fracture requires surgical repair of the bone may not be able to weight bear for eight to 12 weeks. This results in a longer period of inactivity, which carries greater risks for complications, muscle atrophy and loss of flexibility and balance.

"When patients are bedridden, we see a significant decrease in flexibility, strength and balance that begins almost immediately and progresses rapidly," Dr. Abraham said. "This can make ambulation much more difficult and place the patient at risk for another fall. Post-surgical treatment involves working with the patient to preserve as much muscle mass and flexibility as possible."

A third factor is rehabilitation. It’s here where the patient begins to regain use of the injured hip and learns to prevent another fall. "In the early stages, we work with the patient to restore flexibility, balance, gait pattern and ambulation, while we also reinforce precautions related to surgery," Dr. Abraham said. "Then, we help the patient gradually build strength using isometric exercises and learn to safely negotiate position changes - for example, from a bed to a chair. This can often mean the difference between dependence and independence."

The fourth, and perhaps most important, factor in a patient’s recovery from hip fracture involves state of mind.

A patient who is goal-oriented, motivated and supported by loved ones and caregivers will usually achieve a higher level of post-injury functioning than a patient who feels depressed and alone, Dr. Abraham said.

"Psychological status greatly affects recovery," he said. "Depression can strip a patient of his or her desire to get better, and dementia of any kind may diminish his or her ability to carry out home exercises, adhere to surgical precautions and employ fall prevention strategies. Helping patients achieve their maximum functioning includes assessing their mental status and addressing related issues."

For patients like Ruth, recovery from hip fracture depends in part on all these factors - from the level of pre-injury fitness to treatment, rehabilitation and emotional/cognitive state. For members of the health-care team, helping patients like Ruth achieve a positive outcome involves careful attention at every stage of treatment.

"We’ll never get patients back to 100 percent, simply because a hip fracture is such a significant injury," Dr. Abraham said. "But we may be able to help them return to their home, regain some independence and resume many of their normal activities."