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Postop care as important as surgical treatment for femoral neck fractures
Better postop care can significantly improve a patient's ability to return to earlier function levels.
Receiving proper medical treatment after surgical hip repair is crucial to a patient's long-term health and return to preoperative levels of function, according to Kenneth J. Koval, MD, of Lebanon, N.H.
"I think that the postoperative care is more important than the surgical care," Koval told Orthopedics Today. "There needs to be collaborative practice, there needs to be evidence-based guidelines, and there needs to be communication so the patient doesn't fall through the cracks."
Crucial care
While return to preoperative function is the goal of surgery for hip fracture, recent studies show that postop medical care is crucial to fracture repair and avoiding complications.
"There have been multiple studies that document that patients are not getting treatment after hip fracture, in terms of osteoporosis evaluation and management," Koval said.
Patients not stabilized postop have an increased risk of complication. Evidence suggests that early surgical repair within 24 to 48 hours in medically stable patients without active comorbid diseases can have a 1-year reduction in mortality, Koval said.
The American Academy of Orthopaedic Surgeons advocates osteoporosis evaluation and treatment after hip fracture so patients are not discharged without the appropriate follow-up, he said.
"The problem is that everyone treats their own little piece of the patient — they're not treating the whole patient," Koval said.
Often, patients are not managed properly, and physicians are not aware of comorbid conditions, he said. For instance, delirium occurs in 60% of hip fracture patients, and more often than not, it remains undiagnosed.
Not being aware of comorbidities can result in the patient having to stay hospitalized for a longer period of time, increases the risks of morbidity and mortality and can delay rehabilitation.
Koval suggests that hospitals set up "pathways," in which patients follow an order of care so that nothing is left out and all physicians can perform a full evaluation. The patient will then be transferred to the different pathways within that hospital so that they can receive a full medical evaluation and consultation.
Communication is key
Communication is key, he said. Each physician who comes in contact with the patient needs to know what to check for to make sure all of their bases have been covered. This is especially true for orthopedists. "The orthopedist needs to make sure the patient is healing their broken bones and getting appropriate rehabilitation," Koval said.
For more information:
- Koval K. Medical treatment after femoral neck fracture: Does it make a difference? Presented at the 34th Open Meeting of the Hip Society and 12th Combined Open Meeting of the Hip Society and American Association of Hip and Knee Surgeons. March 25, 2006. Chicago.
- Kenneth J. Koval, MD, is with Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756; 603-650-7959.