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Fractured Hip | 마이메르시 MyMerci
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Fractured Hip

NCLEX Review Guide: Fractured Hip

Hip Fracture Fundamentals

Types and Classifications

  • Intracapsular fractures occur within the joint capsule and have higher risk of avascular necrosis due to disrupted blood supply to the femoral head.
  • Extracapsular fractures occur outside the joint capsule, including intertrochanteric and subtrochanteric fractures with better healing potential.
  • Femoral neck fractures are most common in elderly patients with osteoporosis and carry the highest risk for complications.

Intracapsular vs. Extracapsular Fractures

IntracapsularExtracapsular
Higher AVN riskLower AVN risk
Femoral neck/headTrochanteric region
May need replacementUsually ORIF

Key Points

  • Age >65, female gender, and osteoporosis are primary risk factors
  • Most result from low-energy falls in elderly patients

Assessment and Clinical Manifestations

Physical Assessment Findings

  • Classic triad: severe pain, inability to bear weight, and external rotation with shortening of the affected leg.
  • Pain may be referred to the knee or groin area, making diagnosis challenging in some cases.
  • Displaced fractures show obvious deformity, while non-displaced fractures may have subtle findings.

Clinical Scenario

An 82-year-old woman presents after falling in her bathroom. She reports severe right hip pain, cannot bear weight, and you observe her right leg is externally rotated and appears shorter than the left. Suspect hip fracture and prepare for immediate imaging.

Memory Aid: "SHARP"

  • Shortening of leg
  • Hip pain (severe)
  • Abnormal rotation (external)
  • Reduced mobility
  • Pain with movement

Nursing Management

Preoperative Care

  1. Maintain bed rest with affected leg in neutral alignment using Buck's traction or abduction pillow
  2. Assess neurovascular status every 2-4 hours: pulse, sensation, movement, color, temperature
  3. Administer prescribed analgesics and monitor pain levels using appropriate scales
  4. Prepare for surgery within 24-48 hours to minimize complications and mortality risk
Critical Alert: Never attempt to reduce or manipulate a suspected hip fracture - this can cause further damage to blood vessels and nerves

Postoperative Care

  • Hip precautions must be maintained for 6-12 weeks: avoid hip flexion >90°, adduction past midline, and internal rotation.
  • Monitor for signs of dislocation: severe pain, shortening, abnormal rotation, and inability to move the leg.
  • Encourage early mobilization within 24-48 hours post-surgery to prevent complications like pneumonia and DVT.

Hip Precautions Memory Aid: "No FLAIR"

  • Flexion >90°
  • Legs crossing midline
  • Adduction past midline
  • Internal rotation
  • Reaching down to floor

Complications and Prevention

Major Complications

  • Avascular necrosis of the femoral head occurs due to disrupted blood supply, more common with intracapsular fractures.
  • Deep vein thrombosis and pulmonary embolism risk is high due to immobility and surgical trauma.
  • Fat embolism syndrome can occur 24-72 hours post-injury, presenting with respiratory distress, confusion, and petechial rash.
  • Infection at the surgical site requires immediate antibiotic therapy and possible surgical debridement.

Prevention Strategies

  • Early mobilization and physical therapy to prevent muscle atrophy and joint stiffness
  • Anticoagulation therapy as prescribed to prevent thromboembolic events
  • Proper positioning and turning every 2 hours to prevent pressure ulcers

Commonly Confused Concepts

Hip Fracture vs. Hip Dislocation

Hip FractureHip Dislocation
Bone break/crackJoint displacement
External rotationInternal rotation (posterior)
Leg shorteningLeg may appear normal length
Requires surgeryMay reduce without surgery

Quick Check

A patient has a total hip replacement. Which position should be avoided?
A. Sitting in a high chair
B. Lying on the unaffected side
C. Crossing legs at ankles
D. Using an abduction pillow
Answer: C - Crossing legs violates hip precautions

Study Tips and Memory Aids

NCLEX Success Strategy

  • Remember: Safety first - hip precautions prevent dislocation
  • Think circulation - always assess neurovascular status
  • Consider complications - DVT, infection, AVN are high-yield topics
  • Focus on mobility - early movement prevents many complications

Common Pitfalls to Avoid

  • Don't confuse hip precautions for different surgical approaches - posterior approach has strictest restrictions
  • Remember that pain medication alone doesn't treat the underlying fracture - surgical intervention is usually required
  • Buck's traction is for comfort and alignment, not fracture reduction in hip fractures

Self-Assessment Checklist

Can you identify:

Signs and symptoms of hip fracture
Hip precautions and rationale
Major complications and prevention
Difference between intracapsular and extracapsular fractures
Appropriate nursing interventions pre and post-op

You've got this! Hip fractures are a high-yield NCLEX topic. Focus on safety, complications, and patient education. Remember that understanding the "why" behind nursing interventions will help you choose the best answers. Keep practicing and trust your nursing judgment!

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