What is hip fracture repair (hip pinning)?

Activity

• Rest when you feel tired. You may take a nap, but don't stay in bed all day.
• Work with your physical therapist to learn the best way to exercise. You may be able to take frequent, short walks using crutches or a walker. You will probably have to use crutches or a walker for at least 4 to 6 weeks. After that, you may need to use a cane to help you walk.
• Do not sit for longer than 30 to 45 minutes at a time. When you sit, use chairs with arms, and don't sit in low chairs.
• Sleep on your back with your legs slightly apart or on your side with a pillow between your knees for about 6 weeks or as your doctor tells you. Don't sleep on your stomach or affected hip.
• Ask your doctor when it is okay to bathe or shower.
• Ask your doctor when you can drive again.
• Most people are able to return to work 4 weeks to 4 months after surgery.
• Ask your doctor when it is okay for you to have sex.
• Do not lift anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.

Diet

• By the time you leave the hospital, you will probably be eating your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Your doctor may recommend that you take iron and vitamin supplements.
• Continue to drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• Eat healthy foods, and watch your portion sizes. Try to stay at your ideal weight. Too much weight puts more stress on your hip joint.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
• Your doctor may want you to take calcium supplements and eat foods high in calcium, such as milk, cheese, ice cream, and salmon with bones. These help stop bone loss. Orange juice and soy milk with added calcium are also good choices.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Your doctor may give you a blood-thinning medicine to prevent blood clots. If you take a blood thinner, be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems. This medicine could be in pill form or as a shot (injection). If a shot is necessary, your doctor will tell you how to do this.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• You will have a bandage over the cut (incision) and staples or stitches. If there is no drainage, most doctors will let you take the bandage off in a few days.
• Your doctor will remove the staples or stitches 10 days to 3 weeks after the surgery and replace them with strips of tape. Leave the tape on for a week or until it falls off.

Exercise

• Your rehab program will include a number of exercises to do. Always do them as your therapist tells you.
• Do not do any vigorous exercise for 12 weeks or until your doctor tells you it is okay.

Ice and elevation

• Put ice or a cold pack on the area for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake). Put a thin cloth between the ice and your skin.
• Your ankle may swell for about 3 months. Prop up your ankle when you ice it or anytime you sit or lie down. Try to keep it above the level of your heart. This will help reduce swelling.

Other instructions

• Continue to wear your compression stockings as your doctor says. The length of time that you will have to wear them depends on your activity level and the amount of swelling you have. Most people wear these stockings for 4 to 6 weeks after surgery.
• Follow these tips to prevent falls:
  • Arrange furniture so that you won't trip on it.
  • Get rid of throw rugs, and move electrical cords out of the way.
  • Walk only in areas with plenty of light.
  • Put grab bars in showers and bathtubs.
  • Try to avoid icy or snowy sidewalks. Choose shoes with good traction, or consider using traction devices that attach to your shoes.
  • Wear shoes with sturdy, flat soles.

Surgery usually works well, but you will need to be patient. Getting better will likely take a long time. And you may never be able to get around as well as you could before.

Surgery is usually the best choice after a hip fracture, because it stabilizes the bone so you can move around sooner. This helps prevent other problems such as pressure injuries and weakness. Surgery also makes it more likely that the bone will stay in place so the fractured leg is not a little shorter than the other leg after it is healed.

After surgery to repair a hip fracture, you will spend a few hours in the recovery room, and then you will go to your hospital room. You may see a metal triangle called a trapeze over your bed. You can use this to help move yourself around in bed. You will be very tired and will want to rest. Your nurse may also help turn you as you rest.

You will probably still have a tube that drains urine from your bladder (urinary catheter). And you will probably be getting fluids through a tube in your vein called an I.V. You may also have a drain near the cut (incision) on your hip.

You may not feel hungry. You may feel sick to your stomach or constipated for a couple of days. This is common. Your nurse may give you stool softeners or laxatives to help with constipation.

You may have stockings that put pressure on your legs to prevent blood clots. Your nurse may also give you medicines and exercise instructions to help prevent clots.

Most people spend 2 to 4 days in the hospital. But depending on your health before the surgery, you may need to stay longer.

You will probably stay in the hospital for 2 to 4 days after surgery. Your rehabilitation program (rehab) will start at this time. If you don't have someone to help you at home, you may go from the hospital to a short-term rehabilitation center or a long-term care center.

During the first week or so after surgery, you'll need less and less pain medicine. For a few weeks after surgery, you'll probably take medicine to prevent blood clots.

For several months, you may need the help of a walker or crutches. After that, you may need to walk with a cane. At first, you may need help with daily activities such as bathing, dressing, and cooking. Rehab will help you get back to your regular activities. But it will probably take at least 3 months to return to your normal routine. It may take 6 months to 1 year for you to fully recover. Some people, especially older people, are never able to move as well as they used to.

• You will slowly return to most of your activities.
  • You may be able to walk on your own in 4 to 6 weeks. Until then, you will need crutches or a walker. After that, you may need to walk with a cane.
  • Ask your doctor when you can drive again.
  • You may be able to return to work in 4 weeks to 4 months, depending on your job.
  • Your doctor will tell you when you can walk, swim, dance, golf, or bicycle. Ask your doctor about other activities you would like to do.
  • Your doctor may advise you to avoid more strenuous activities, such as running or tennis, or those where a fall is possible, such as horseback riding or skiing.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take 2 to 4 hours.

Surgery is done to keep the broken pieces of the hip in place so they can heal faster. Some kinds of broken bones heal on their own in a cast. But a broken hip is not likely to heal well without surgery.

The surgery takes 2 to 4 hours.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

The risks of hip repair surgery can be divided into two groups:

• Risks of the surgery and recovery period, such as:
  • Bleeding.
  • Infection.
  • Blood clots.
  • Delayed wound healing.
  • Problems with the anesthesia.
• Long-term risks that may happen, or may be noticed, months to years after the surgery. Some of these problems may happen with or without surgery but are more likely if you don't have surgery. They include:
  • Nonunion. This means the pieces of bone don't heal back together.
  • Fracture around the screws, nails, or rods used to repair the bone.
  • Difference in leg length. This means that when the fractured leg is healed, it is a little shorter than the other leg.
  • Problems with the blood flow inside the bone. This can cause part of the bone to die (osteonecrosis).

Surgery for a hip fracture repairs a broken hip bone. Broken hips are often caused by a fall or other injury. Some kinds of broken bones heal on their own in a cast. But a broken hip is not likely to heal well without surgery.

This type of surgery is usually done right after a hip breaks.