Delaying medical treatment to a fractured hip by 24 hours can turn dangerous for the patient. A 45-year-old Ranjan (name changed) slipped and fell from stairs at his house in Bahadurgarh. Although he had suffered minor external injuries, he experienced severe pain on his right hip and was unable to move.
However, Ranjan and his family decided to remain home and apply ice packs at the pain area. It was only on the 3rd day after the accident that he could not bear the pain any further and was taken to a Delhi Hospital.
“Upon investigation, we found that the patient fractured his hip due to the fall. He was hypertensive and we could operate on him only after controlling the high blood pressure, causing a gap of more than 60 hours between the time of fall and the operation. Ideally, a patient should have come within 24 hours for treatment. The delay in coming for treatment had complicated matters as the patient developed avascular necrosis of the femoral head which basically results in the interruption of blood supply to the bone. However, a successful procedure was conducted without much danger to the patient’s life”, said Dr.Deepak Raina, Sr.Consultant cum Chief of Hip Services, Indian Spinal Injuries Centre.
According to researches, the increased wait time was associated with a greater risk of 30-day mortality (death within 30 days) and other complications, including myocardial infarction, deep vein thrombosis, pulmonary embolism, and pneumonia in adults undergoing hip fracture surgery.
Ideally a hip fracture should be treated within 24 hours and waiting any longer increases the risk – nearly 12 percent of such hip fracture patients died within the month following their surgery.
“It is absolutely necessary to take the affected person to the hospital once a fracture is confirmed as some time has already lapsed by then. However, in many of the hospitals, especially in rural or semi-urban areas, operation facilities are not readily available due to the want to doctor, medicine, or equipment. This causes delay which not only prolongs the patient's pain and suffering, but also is associated with lower rates of nonunion, avascular necrosis of the femoral head, urinary tract infections, decubitus ulcers, pneumonia, venous thromboembolism, and death. Longer postoperative stay, delayed postoperative rehabilitation, and increased risk of deliriumincreases mortality and complications in elderly hospitalized patients,” says Dr.Deepak Raina, Sr.Consultant cum Chief of Hip Services, Indian Spinal Injuries Centre
Patients who are operated upon within 24 hours were 21 percent less likely to die during the following month, compared with those who had a delay in surgery. Such patients also had lower complication rates and were 82 percent less likely to develop a blood clot in the leg veins (deep vein thrombosis); 61 percent less likely to have a heart attack; and 49 percent less likely to suffer a blood clot in the lung (pulmonary embolism). They were also 5 percent less likely to develop pneumonia during the month following surgery.
Symptoms of hip fracture:
· Inability to move immediately after a fall
· Severe pain in your hip or groin
· Inability to put weight on your leg on the side of your injured hip
· Stiffness, bruising and swelling in and around your hip area
· Shorter leg on the side of your injured hip
· Turning outward of your leg on the side of your injured hip
Possibility of hip fractures increases substantially with:
· Age, as bone density and muscle mass tend to decrease with age.
· About 70 percent of hip fractures occur in women as they lose bone density faster than men, in part because estrogen levels drop with menopause that accelerates bone loss.
· Chronic medical conditions like endocrine disorders can lead to fragile bones while intestinal disorders may reduce absorption of vitamin D and calcium, leading to weakening of bone. Medical conditions that affect the brain and nervous system, including cognitive impairment, dementia, Parkinson's disease, stroke and peripheral neuropathy, also increase the risk of falling.
· Cortisone medications, such as prednisone, can weaken bone if you take them for long. Drugs that act on central nervous system — such as sleep medications, antipsychotics, and sedatives— are most commonly associated with falls.
· Physical inactivity. Weight-bearing exercises, such as walking, help strengthen bones and muscles, making falls and fractures less likely. If you do not regularly participate in weight-bearing exercise, you may have lower bone density and weaker bones.
· Tobacco and alcohol use can interfere with the normal processes of bone building and maintenance, resulting in bone loss.
