DYNAMIC HIP SCREW (D.H.S)

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1 DYNAMIC HIP SCREW (D.H.S) Information Leaflet Your Health. Our Priority.

2 Page 2 of 8 You have fractured (broken) your hip. This is a common injury following a simple fall. The x-rays show that you have a fracture below the hip joint. To enable this fracture to heal and to prevent the fracture from moving; you need to have an operation. The operation involves using a plate with screw (Dynamic Hip Screw) to hold the fracture. We know that you have just come into hospital, but we need to start thinking about your discharge from the start. You will be given an estimated date of discharge, however this may change. What can I do about the pain? You will be given regular painkillers either in liquid, tablet or injection form. If you are in any pain, don t try and put up with it. Please tell a nurse as soon as possible. What investigations do I need? Prior to you operation you will need to have some investigations to ensure that you are in the best possible medical condition for the operation. Some of these investigations will have been done in the Accident and Emergency department, and include blood tests, chest x-ray and a recording of your heart (ECG). Can I eat and drink? For 6 hours before your operation it is important you don t have anything to eat and drink, even water. Your stomach needs to be empty before your operation to prevent any vomiting during and after the surgery. After your operation you can start by taking sips of water, and when tolerating fluids you may have something to eat. A good diet is important for wound and bone healing; therefore regular build up drinks will be offered to you if you are not eating enough. Build ups are milky drinks containing extra vitamin and minerals. Do I have to lie in any certain position while my hip is broken? No, you can lie in any position that is comfortable for you. How do I go to the toilet? Before your operation you will use a bedpan. For the first few days after your operation you can be wheeled to the toilet. Once you are walking with a frame a nurse will walk to the toilet with you. How do I avoid constipation? Due to a reduction in mobility and the use of painkillers you may become constipated. To avoid this it is important to drink plenty of fluids and eat a diet high in fibre. However to prevent this problem we will start you on medication that will help you have your bowels opened. Please let the nursing staff know if your normal bowel habit has altered.

3 Page 3 of 8 When will I have my surgery? We plan to get you to theatre as soon as possible following the results of any necessary tests, and most patients will have their operation within 48 hrs. Who will I meet? Nurses They will care for you during your stay, and will provide explanations regarding investigations and procedures. They will provide you and your family with support during this time. Trauma Nurse team They will list you for your surgery, and explain any delays in surgery. They are the key contact person regarding the timing of your operation, and will explain the pre-operative period to you. You will be under the joint care of a consultant orthopaedic surgeon and a consultant physician Orthopaedic surgeons Who will manage the surgical aspect of your care. Physicians Who will manage the medical aspect of you care. Orthopaedic Medical staff They will care for your surgical and medical needs during your stay Advanced Nurse Practitioners/Orthogeriatricians They will review you most days. This will help prevent any medical complications that may occur. The doctors / nurse clinician are available to answer any questions or worries you and your relatives may have. Physiotherapists Shortly after your operation, one of the physiotherapists will see you. They will start your rehabilitation with a walking frame. You may move onto crutches once you are able. Exercises can be shown, to help improve the muscle strength in your hip. Occupational therapist They will ensure that you are able to carry out daily living activities such as getting dressed and preparing a meal. If needed they will order equipment for you to use in your home e.g. commode. Social worker If needed the social worker will asses your situation to see if you will need any extra help when you go home.

4 Page 4 of 8 What Anaesthesia will I have? The anaesthesia will be either a general anaesthetic or a spinal anaesthetic. A general anaesthetic is where you are sent to sleep before the operation starts, and you are woken up when everything is finished. A regional (spinal anaesthetic) is when a local anaesthetic is placed in the back; this makes the area below your waist numb. With this anaesthetic you may be given medicine that makes you feel more relaxed during the operation. The anaesthetist will discuss the possible options with you. How is the operation done? The operation can usually be performed through a 6 inch wound on the outside of the thigh. A plate is attached to the Femur (thighbone) and a screw placed across the fracture to hold it in position. The operation usually takes less than one hour to perform but your time in theatre may last up to 2 ½ hrs taking into account anaesthetic and recovery time. You may have a drain in your hip to remove fluid from the wound and prevent complications; this will be removed after 24 hours. Will I have a wound? Yes, the wound is usually between 6 and 9 inches long, which will be held together with stitches. This will be covered with a dressing. What are the advantages of having the operation? Fixing the fracture with plate and screws will relieve some of the pain allowing you to start to mobilise and hopefully allow the fracture to heal successfully. What if I don t have the operation? If you don t have the operation, you will need to remain on bed rest until the fracture starts to heal. This may take 2 3 months. Walking on the fracture could cause it to displace. Prolonged bed rest while the fracture heals can lead to problems such as: Deep vein thrombosis/pulmonary embolism Pressure sores Pressure sores or bed sores form when there is constant pressure on a part of the body, and the blood supply of the skin shuts down. This results in damage to that area. Chest infections This can occur when your lungs are not fully inflating due to being in bed. You are encouraged to take deep breaths 10 times an hour to prevent chest infections. The nurse clinician/doctor will also examine your chest to detect early infection.

5 Page 5 of 8 Non union This is when the fracture does not heal. Malunion This is when the fracture heals in an abnormal position. What can go wrong? Surgery for this type of fracture is a big operation. Most people who sustain this injury are elderly and may have existing medical problems such as heart or lung problems. Following the injury and after the surgery, some patients can develop heart and lung problems, which may require further treatment. General complications may include Chest infection, heart attack and stroke; these complications increase if you have history of these problems. Other complications include the following: Bleeding It is not unusual for a little bleeding to occur into a dressing and this should not cause concern. Rarely more severe bleeding occurs around the wound making it swollen and uncomfortable, this usually settles with time. Infection To reduce the risk of infection, the operation is performed under sterile conditions in a specially designed theatre. You are also given antibiotics in theatre to reduce this risk. However, despite these precautions, the infection rate following this operation is about 1-5 %, although some of the infections are superficial and settle down. An infection around the screws may lead to failure of the fixation. Fixation Failure In a small number of patients, where the bone is extremely soft, the screw and plate can lose their grip on the bone or loosen in the bone. If this happens it is likely that you will need a further operation on your hip. Deep vein Thrombosis/ Pulmonary embolism A clot can form in the veins of your leg and bits can break off and travel to the lungs. To help prevent this complication, we put you on a daily injection to slightly thin the blood- this injection is continued for 28 days after your operation. If you are discharged before this time we can arrange a district nurse to give you this injection. Urinary retention/ Infection Surgery around the hip can sometimes cause patients to develop a problem passing urine. This can be painful and is treated by passing a tube (catheter) into the bladder. The catheter is then removed a few days after the operation. In most people this problem settles after the operation when they start to mobilise.

6 Page 6 of 8 Confusion Following a hip fracture, you are very prone to confusion or delirium, this can be very distressing to you and your relatives. Delirium is a sudden change in the brain function and can be due to many causes such as infection or a change in environment. In most cases delirium settles, however it may be necessary to perform investigations to find the cause of the delirium Is anything done to prevent me getting MRSA? Yes, MRSA is taken very seriously. On admission your nose will be swabbed. Before we receive the results of the swabs, treatment will be started. When the results of the swabs are available we will decide if you need to continue with the treatment. You may not wish to go ahead with this preventative treatment, in which case your surgery will not be delayed. As bacteria s such as MRSA can be passed on from person to person, health care staff will clean their hands before and after contact with you. It is also advised that both patients and relatives clean their hands regularly. For further information please ask a member of staff. When can I start to get up after my operation? The day after your operation you can start to get up. The nursing staff and Physiotherapist will help you and advise you if you can put weight through your leg. Can I prevent further fractures? After the menopause your bones start to lose strength. If you have fractured your hip following a fall from standing height, your bones may be weak. Weight bearing exercise such as walking and a diet high in calcium can help strengthen bones. Stopping smoking and reducing alcohol can also improve bone strength. While you are in hospital the nurse clinician/medical doctor will assess your risks of further fractures. If appropriate she will start you on medication that will help strengthen your bones. Is there anything I need to know? We have asked your relative to bring in a picture of you when you were younger; this is interesting for the nursing staff and also stimulates different conversation. Please let your relative know if you do not want a picture bringing in. When do my stiches come out? Your stitches come out after 12 days; if you have gone home before this time, we will arrange a district nurse or your practice nurse to remove them.

7 Page 7 of 8 When will I go home? You should aim to go home as soon as you and the healthcare team feel you are able to manage safely at home. Everyone is different, so the time spent in hospital varies. If you are fit you may go home within one to two weeks, if you have medical problems you may be in hospital longer. The doctors and nurses may feel you would benefit from further rehabilitation. If this is the case you will be transferred to a community rehabilitation bed. An Estimated Date of discharge will be given to you on admission What do I need to know once I have been discharged? You can experience pain for up to 12 months following a hip fracture; however the pain should decrease with time. If you feel your pain is getting worse you should contact your GP. It is important to continue a good diet to help with wound and bone healing. There is no follow up following a hip fracture, if you are experiencing any problems it is advisable to contact your GP. Please ensure you have read your osteoporosis leaflet and know how to take you bone protection medication. Members of nursing staff are also available for advice Nicky Makepeace - Nurse Clinician Dawn Chambers - Senior Ward Sister M

8 Page 8 of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Information Leaflet. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number TO44 Publication date November 2013 Review date November 2015 Department Medicine Location Stepping Hill Hospital

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