These notes are provided for possible use by clinicians in discussing investigations and treatment options with patients who have fractured their hip. They are not intended for direct distribution to patients, but might be incorporated into locally-developed patient information materials.

Prevention

• Patients should be encouraged to be active - a history of immobility is a significant risk factor for fracture.
• Identify any factors that might reduce the risk of the patient falling if they were addressed in advance. For example:
  • at home - e.g. loose rugs, trailing flexes etc.
  • has the patient's eyesight and/or hearing been tested/checked recently?
  • would the use of walking aids be beneficial, or could their current use be optimised?
  • are there other appliances that could be prescribed for home use?
• All patients who have been assessed as being at risk of hip fracture should be prescribed calcium and vitamin D. It should be explained to the patient that taking these tablets will help to reduce the risk of fracturing the hip if they should fall.
• Patients who are asked to use hip protectors should be encouraged to stick with them. Although they may be uncomfortable to wear, studies have shown that they really do reduce the risk of fracture.

Early mobilisation

• The importance of early mobilisation following a hip fracture operation should be emphasised:
  • let patients know in advance that they will be encouraged to move within 24 hours of their operation
  • acknowledge that starting to walk again is a challenge and will be uncomfortable.

Pain control

• Pain control is important to promote mobilisation and patients should be encouraged to take pain medication as offered, so that they are comfortable in bed and when exercising with the physiotherapist.

Rehabilitation and discharge

• From the beginning, patients should be encouraged to think ahead, not just about getting back on their feet, but also about getting home.
• Patients should be made aware, that for this reason, ward staff, in particular physiotherapists and occupational therapists may need information about their home and social circumstances in order to make any necessary arrangements for additional support or equipment needed on discharge from hospital.

Further information

Further information for patients is available from other sources. For example, the booklet Coping with Hip Fracture produced by the National Osteoporosis Society is free to patients and carers. It explains what to expect during time in hospital; how to look after oneself during convalescence and how exercise, diet and changes in the home can play a central role in recovery. Available from the National Osteoporosis Society, PO Box 10, Radstock, Bath BA3 3YB. Tel: 01761 471 771, http://www.nos.org.uk e-mail info@nos.org.uk.