Hip fracture is most common in the elderly and statistics indicate that fracture numbers will continue to increase, as Thailand is currently an aging society. A number of people may see hip fracture as a normal occurrence; however, if medical treatment is not received it could prove to be fatal.
Doctor Sombat Rojviroj, Orthopedic Surgeon at Bangkok Hospital indicates that currently the most common health issues for older people are hip fractures. Records show that within the first year 20 percent of hip fractures will result in fatality and cause paralysis. 40 % will be unable to walk without assitance and 60 % will become reliant on others for day-to-day activities.
With these statistics in mind, the Bangkok Fracture Center was created to support and develop a standardized treatment procedure for fractures, which achieve improved results. This is arrived by using appropriate techniques for treating hip fractures in the elderly, by keeping in mind that older patients may have a pre-existing condition and thus a higher risk of complications and fatality.
“It is quite a complicated decision-making proccess for the surgeon who must select the best treatment option available. This involves a thorough assessment of the patient. A multidisciplinary team of medical personnel with specialized expertise and experience in dealing with fractures who coordinate to ensure best results of the treatment method/s selected and without aggravating any other conditions the older patient may be suffering from.
The Hip Fracture Pathway helps in this way, providing a high standard for facture treatment in older patients specifically“.
The 3 main fractures that concern older patients are the wrist, the spine, and the hip, depending on how they fall. However, a wrist fracture or collapse of back disc should not prove fatal. Furthermore, surgery is not always required to treat hip fractures, although the patient may expect to stay in bed and remain immobile for a period of time to prevent complications. However, being bed-ridden for a long period of time can also lead to bedsores, bladder infection, pneumonia, which could ultimately lead to death”.
Dr. Sombat says,“If your hand or wrist is fractured, it can be put into a cast. A spine fracture may not necessarily cause paralysis and you may still be able to walk. However, a hip fracture can lead to serious complications. From experience 90% of patients who suffered hip fractures that do not receive surgical treatment will be unable to walk. Some patients may be lucky as the bone may rejoin within 2-3 months without the need for surgery. The sooner the surgical treatment, the shorter the recovery time, and the less pain the patient will have to endure, and the sooner he/she will be able to return to daily activities. When dealing with older patients it is important to provide fast treatment, minimalize pain, and prevent chance of complications “.
Dr. Sombat indicates that family members should pay close attention if an older relative falls and immediately bring them to the hopsital for examination. This will help to determine whether or not a fracture has occurred. If there is any suspicion of hip fracture the patient should be sure to not attempt to move about as he or she normally would. If the patient is unable to get up, carers should not assume that it is a result of natural deterioration or other conditions such as Alzheimer’s or depression.
Bangkok Hospital provides specialized orthopedic surgeons for the treatment of hip fractures, which follows a standardized pathway of geriatric care. They are supported by a multidisciplinary team of geriatricians, rehabilitation specialists, nutritionists, and physical therapists. The patient will receive a full check-up and assessment prior to surgical treatment. They will also receive diagnosis of factors specific to the elderly such as confusion, ability to perform daily activities, susceptibility to falls. Surgical treatment can be provided within 36 hours and research has shown that prompt treatment will lead to less complications and a faster recovery period.
“Having a standardized treatment pathway specifically designed for hip fracture in the elderly helps to ensure that all proccesses are fast, accurate, and safe. This will result in higher positive outcomes for the patient. Forecasts indicate that there may be approximately 100 hip fractures per day in the future, as such it is important that these patients receive timely care to prevent unnecessary complications“.
Treatment for hip fractures in the elderly will depend on each patient and the location of the fracture. Treatment includes 2 methods: the first is Hip Replacement Surgery, and the second is Minimally Invasive Plate Osteosynthesis (MIPO). Other complications must be taken into consideration such as osteoarthritis, as well as prevention of blood clots. Another important aspect of treatment is rehabilitation through physical therapy, such as the use of equipment to help the patient walk, new medical technology such as the Alter G (anti-gravity treadmill) will be used, as well as water therapy. An assessment and training of proper balance will help to prevent the chance of a future fall causing another fracture.
Furthermore, specialized geriatricians will be involved (before and after surgery) in several dimensions of care that may include chronic conditions, bone conditions, brain and neurological conditions. This specialized healthcare approach will ensure that there are fewer complications allowing the patient to return to normal activities as soon as possible.