Consequences of a hip fracture for nursing home residents

Hip fractures are the second most common cause of hospitalizations in residents aged 65 and older and the sad news is many of them could be avoided.

If you or a loved one suffers a hip fracture in a hospital, nursing home or long term care facility, it is important to understand the potential consequences of the injury and the legal remedies you could seek as a result.

Hip fractures can be avoided when proper care plans are in place. Unfortunately, one in five residents die within one year of a hip fracture.

Types of hip fractures

There are two main types of hip fractures in elderly people and both can be very serious. Surgery is typically recommended to repair both types of fractures.

1. Femoral Neck Fracture

The femoral neck is just below the ball (head) of the ball-and-socket hip joint. This type of fracture can diminish, and sometimes stop, the flow of blood to the broken part of the bone.

Surgery is typically required to repair the fracture and return the flow of blood to the fractured area. With this type of fracture a partial hip replacement is completed to replace the fractured head of the ball-and-socket hip joint with a stainless steel or chrome cobalt alloy metal prosthesis.

1. Intertrochanteric Region Fracture

Below the femoral neck (the head of the femur) is where the thigh bone comes out. An intertrochanteric region fracture runs between the two bumps (trochanters).

To repair this kind of fracture a hip nail (think of a large screw) and a metal plate are used to place the bones in the correct position. The hip nail and metal plate bring the bones together to heal alongside each other.

What causes hip fractures in residents aged 65 and above?

Many factors can contribute to a hip fracture in an elderly resident, they include, but are not limited to:

• • Age and gender
  • Medications
  • Trip or falling hazards in the nursing home or room
  • Osteoporosis
  • Dementia
  • Muscle weakness
  • Dehydration
  • Poor eyesight

Because so many factors may contribute to hip fractures in elderly residents, it is important for a nursing home or long term care facility to have proper care plans in place. This means that the facility must do a thorough initial assessment when a resident is admitted.

After the initial assessment, the facility must continue to monitor the resident for any changes, including those that might contribute to hip fractures. If the facility completes a thorough intake and assessment of the resident, safety measures may be implemented to prevent resident falls and hip fractures.

If the resident is not assessed on a regular basis, changes in the resident’s condition may go unnoticed. If the changes in the resident are not properly investigated and documented by the facility’s staff members, the proper safety measures may not be in place to protect the resident. The safety measures, such as restraints or bed alarms, may be the difference between a hip fracture and a healthy resident.

Is there a difference in outcome if a hip fracture chooses to have surgery or not?

The short answer is yes.

Studies have shown that hip fracture patients that do not have surgery compared to those that do have surgery have much worse outcomes, with pain and mobility being significant factors in the outcome.

Failure to undergo surgery can result in significant pain for the patient, including on pieces of broken bone rubbing together.

Other procedures may be used to manipulate the bones back to the correct position. However, this leads to increased time in bed, leading to a further decline in mobility and conditioning.

Why are the consequences of a hip fracture so serious?

An unfortunate statistic of hip fractures in elder nursing home residents is that 20% of residents pass away within a year of the injury.

So why do hip fracture residents decline so quickly after being relatively healthy before a hip fracture? And why do the hip fracture residents rarely return to pre-injury status?

Hip fractures result in significant decline in mobility. You are much more likely to be confined to a bed or wheelchair following a hip fracture. This causes a decline in conditioning and muscle weakness, leading to further fragility.

A nursing home resident that suffers a hip fracture also usually has additional medical conditions. When the hip fracture occurs, the resident’s body comes under enormous stress due to pain, limited mobility, and oftentimes surgery. Often due to the resident’s age, pain and limited mobility, post-surgical complications are extremely common.

These post-surgical complications usually result in longer stays in nursing homes, and sometimes permanent placement in nursing homes.

Post-Surgical Complications

Unfortunately post-surgical complications are common with elderly hip fracture patients. Patients may experience one or more of the following after undergoing hip fracture surgery:

• Unsuccessful surgery: Unsuccessful surgery is always a risk, especially with an elderly patient. If the patient has fragile bones, the partial hip replacement may dislocate before it is properly stabilized. In addition, the hip nail and metal plate may not adhere to the bone.
• Delirium: Delirium is the most common complication after hip fracture surgery. It is important for a facility to implement proper pain control measures and make sure that the resident is oriented frequently.
• Blood Clots: Venous Thromboembolism (also known as VTE) is another common complication of hip fracture surgery. More commonly known as blood clots, this is a very serious condition that can lead to death if not properly treated.
• Infection: Urinary tract infections are the most common infection seen in residents after hip fracture surgery. This is typically due to urinary catheterization, which must be closely monitored so that infection does not spread. Failure to properly manage a urinary catheter or urinary tract infection may cause sepsis or death.
• Bed Sores (Pressure Sores/Pressure Ulcers/Decubitus Ulcers): Bed sores are another common complication after hip fracture surgery. See our article on the causes and symptoms of bed sores [here]. (link to bed sore causes and symptoms page)

What steps can a nursing home take to prevent hip fractures?

The truth is that many hip fracture injuries are the result of accidents or falls that could have been prevented.

The following safety measures should be implemented to promote resident safety:

• • Proper lighting: Lighting should not be too dim in nursing homes and long term care facilities. In addition, the light switches should be easily accessible to residents so that they do not have to ambulate a far distance or reach over cumbersome furniture to turn on a light
  • Carpets and rugs should be secured: so that they do not cause tripping hazards to residents. Residents in nursing homes often have difficulty ambulating and moving around. In addition, a resident’s coordination may be lacking and could result in a serious fall if he or trips over a rug.
  • Furniture must be stable: It is not a good idea for a nursing home or long term care center to have chairs or other furniture that have wheels. In addition, the nursing home or long term care facility should be sure to have chairs with arm rests. This ensures that the resident has something to hold on to or grab while he or she is getting in or out of the chair.
  • Items should be accessible at waist level or below: If a resident must reach and contort their body in awkward positions to reach an item, it could result in a serious fall.
  • Stairways and long hallways should have handrails: Handrails should be seen throughout a nursing home or long term care facility. Because residents usually have difficulty ambulating, it is reasonable to have handrails easily accessible to residents as they ambulate throughout the facility.

Can you file a legal claim for a hip fracture?

This will depend on the circumstances that caused the injury.

Nursing homes have a duty of care for all their residents and if it can be shown that they were negligent in that care and this caused the hip fracture then you may have legal recourse.

The legal team at Thompson Law have years of experience investigating and representing residents who have suffered many different forms of nursing home abuse and neglect.

If you’d like to find out more about your different legal options following a hip fracture injury, speak to one of our team today.