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-Falls (most common cause):
The incidence of a hip or pelvic fracture being caused from a fall increases with age but can also result from a person of any age falling from a substantial height (Fracture (hip), 2019).

-Osteoporosis & skeletal disease:
Although falls are the most common cause of hip & pelvic fractures, women who are postmenopausal that have developed osteoporosis or anyone that is diagnosed with a skeletal disease are most vulnerable for the result of a fracture from a fall (NYU Langone Health, 2020).

-Traumatic Injury:
These types of fractures are also commonly caused from the occurrence of trauma. Motor vehicle accidents, crush injuries, blast injuries, or penetrating trauma to extrapelvic organs are all examples of a traumatic injury that may result in a hip or pelvic fracture (Fracture (hip), 2019).

-Cancer metastasis:
Many different types of cancer may spread to the bone and causes them to become weak. Breaks due to metastatic cancer can happen in any of the bones in the body, but commonly happens in the hip, pelvis, spine, and leg bones due to the body bearing most of its weight on these bones (American Cancer Society, 2020). When the bones become weaker, they are more susceptible to breaking.

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Hip fractures are typically treated with bedrest until repaired by surgical intervention, pain management, and possibly Buck’s extension traction (Fracture (hip), 2019). Surgical interventions for hip fractures help to quickly mobilize the patient and avoid secondary complications. The most common surgical treatments include; an open or closed reduction with internal fixation, a hemiarthroplasty (replacement of the femoral head with a prosthesis, a total hip arthroplasty, and closed reduction with percutaneous pinning (Hinkle & Cheever, 2018). After surgery the main treatment goals include; pain management, adequate fluid and nutrition intake, early mobilization as soon as possible after surgery, physical therapy initiated quickly, and prevention of complications related to surgery (Fracture (hip), 2019).

Pelvic fractures have two categories that require different treatment options.
1. Stable: A stable pelvic fracture is typically treated with temporary bed rest and pain management. It is important to maintain adequate nutrition and fluid intake to promote healing, as well as doing physical therapy such as ankle and leg exercises. Promoting deep breathing, logrolling, skin care, and antiembolism stockings help reduce the risk of complications and can help ease the patient’s discomfort. As the pain reduces, activity increases with the use of assistive devices with the goal of full weight-bearing status by 3 months post injury. (Hinkle & Cheever, 2018)

2. Unstable: There is a high mortality rate associated with unstable pelvic fractures due to the complications that can occur, such as a hemorrhage, the advanced trauma life support guidelines are coordinated with the trauma team (Fracture (pelvic), 2019). The first step in treatment is stabilizing the pelvic bones and using an external binding and stabilizing device to help compress bleeding vessels. Once the patient is stable, they will be sent to surgery to have an external fixation or ORIF. Once the patient is out of surgery the focus of treatment is on pain management, adequate nutrition and fluid intake, and rehabilitation to regain mobilization. (Hinkle & Cheever, 2018).

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Special Equipment Used- Surgical Repair 

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Special Equipment Used- Surgical Repair 

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Hip fractures may need to be surgically repaired.  In that case, they would use options such as an artificial replacement, screws, plates, and rods with internal or external fixation (Mayo clinic, 2020).

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Special Equipment Used- Abduction Pillow 

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Special Equipment Used- Abduction Pillow 

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If a patient has a hip replacement due to the fracture or if a hip dislocation is suspected, the use of an abduction pillow would be necessary. This device helps to immobilize the hip and legs and prevents the patient's hip from dislocating (Hinkle, 2018).

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Special Equipment Used- Assistive Devices

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Special Equipment Used- Assistive Devices

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The use of assistive devices is imperative while the patient is recovering from a hip or pelvic fracture. Typically, the patient would use a walker or cane for ambulation (Hinkle, 2018).

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Pelvic binders are used when the fracture is unstable and needs additional support.

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-Manage pain with pharmacological measures

-Opioids or PCA

-Anti-inflammatory agents to prevent revision surgery

-Manage pain with non-pharmacological therapy

-Bed rest-proper sleep hygiene can encourage healing.

-Traction, such as Buck or Russell (can be used prior to surgery as well).

-Casting, such as hip spica cast.

- Promoting mobility to increase muscle strength, balance, healing and prevent stiffness.

-May be started as early as one day after surgery

-Physical therapy to assist with completing ROM exercises.

-Demonstration of proper use of wheel chair and walker.

-Occupation therapy will assist to encourage independence with ADL’s

-Prevent of infections

-Antibiotics

-Respiratory exercises, such as incentive spirometry.

-DVT prophylaxis

-Anticoagulants

-Compression stockings.

-Bone density enhancers to prevent further fractures.

-Bisphosphonates

(Pearson, 2015)

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In educating the patient on hip and pelvic fractures, its important to explain what kind of fracture they have, what diagnostic procedures and treatment is necessary and surgical processes if necessary, as explained in the previous sections (Fracture, (hip), 2019).
In addition, its important to include the following teaching points:

-Medications:

-Medication regimen and importance of adherence

-Possible adverse effects such as constipation with use of opioid analgesics

-Safe use, storage, and disposal of opioids, if prescribed

-Common medications used include:

-Analgesics, such as morphine sulfate or oral opioids

-Anticoagulation medications

-Antibiotics to prevent and treat infection

-Non-pharmacological measures to aid in treatment and recovery processes, as mentioned

-Range of motion exercises, including how and when to safely perform them, if indicated

-Importance of meticulous skin care, including post-op wound care or incision site care

-Proper body alignment during recovery

-Signs and symptoms of complications or infections to monitor for and report

-Safe ambulation, including proper use of assistive devices, as previously mentioned

-Home safety measures and modifications to ensure a safe living arrangements

-Elimination of trip/fall hazards such as rugs, cords, or items in walkways

-Installation of rails/handles in bathrooms or areas with increased fall risk

-Rearrangement of home to better accommodate altered mobility

-Importance of nutritional habits, including balanced diet and adequate fluid intake

-Importance of follow-up care to evaluate healing
-Effective coping techniques and resources available for emotional and psychological support

(Fracture, 2019).

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American Cancer Society. (2020). Managing Symptoms of Bone Metastases. Retrieved July 17, 2020, from https://www.cancer.org/treatment/understanding-your-diagnosis/advanced-cancer/managing-symptoms-of-bone-metastases.html

Fracture (hip). (2019). In Lippincott advisor for education. Retrieved from: https://thepoint.lww.com/Library/

Fracture (hip). (2019). In Lippincott advisor for education. Retrieved from: https://thepoint.lww.com/Library/

Hinkle, J.L., & Cheever, K.H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins. (E-book)

Mayo Clinic. (2020). Hip fracture. Retrieved from https://www.mayoclinic.org/diseases-conditions/hip-fracture/diagnosis-treatment/drc-20373472

Nursing: A concept-based approach to learning (3rd ed.). (2015). Hoboken, NJ: Pearson.

NYU Langone Health. (2020). Types of Hip &Pelvic Fractures.  Retrieved July 17, 2020, from https://nyulangone.org/conditions/hip-pelvic-fractures-in-adults/types

Pelvic Fractures: ED Presentations and Management. 28 May 2017, www.emdocs.net/pelvic-fractures-ed-presentations-management/