The client with a hip fracture will most likely have a misalignment. Most hip fractures can be diagnosed, or at least suspected, from history alone. Classically a fall leads to a painful hip with an associated inability to walk. Clinicians should explore potentially sinister causes of the fall, such as syncope, stroke, or myocardial infarction.

Option A: Pain is a prominent feature in all fractures. The physical examination will demonstrate pain, immobility, and potentially a deformed limb. The degree of deformity seen is dependent on both the anatomical configuration of the fracture and the degree of displacement. The classically described presentation is a shortened and externally rotated limb due to the unopposed pull of the iliopsoas muscle that attaches to the lesser trochanter.
Option C: Coolness of the extremities is indicative of compartment syndrome. Further examination often reveals pain on any, or all, of the following: palpation in the groin or greater trochanter, axial loading of the hip, and ‘pin rolling of the leg. It is recommended that a cognitive assessment be performed in all patients presenting with hip fractures. Ideally, this should be done both on admission and post-operatively. The aim of this is to recognize patients with underlying dementia or those who are developing an acute delirium, both of which are associated with a poorer prognosis.
Option D: The absence of pulses is indicative of peripheral vascular disease. A full primary trauma and secondary trauma assessment should be performed to assess the patient for other injuries. It is always useful to assess the patient’s cardiovascular and respiratory status prior to undergoing surgery. Specific examinations to identify the cause of the fall should also be considered.

After menopause, women lack hormones necessary to absorb and utilize calcium. Primary osteoporosis is related to the aging process in conjunction with decreasing sex hormones. The bones have deterioration in microarchitecture leading to loss of bone mineral density and increased risk of a fracture. Osteoporosis is defined as low bone mineral density caused by altered bone microstructure ultimately predisposing patients to low-impact, fragility fractures. Osteoporotic fractures lead to a significant decrease in quality of life, with increased morbidity, mortality, and disability.

Option A: Risk factors for osteoporosis include increasing age, body weight less than 128 pounds, smoking, family history of osteoporosis, white or Asian race, early menopause, low levels of physical activity and a personal history of a fracture from a ground-level fall or minor trauma after the age of forty. Patients afflicted with conditions affecting overall mobility level, such as spinal cord injuries (SCI), can experience rapid deterioration of bone mineral density levels within the first 2 weeks following these debilitating injuries.
Option C: Taking calcium supplements can help to prevent osteoporosis but are not causes. Osteoporosis is caused by an imbalance of bone resorption and bone remodeling leading to decreased skeletal mass. In most individuals, bone mass peaks in the third decade, after which bone resorption exceeds bone formation. Failure to reach a normal peak bone mass or acceleration of bone loss can lead to osteoporosis.
Option D: Body types that frequently experience osteoporosis are thin Caucasian females, but they are not most likely related to osteoporosis. In white men, the risk of an osteoporotic fracture is 20%, but the one-year mortality in men who have a hip fracture is twice that of women. Black males and females have less osteoporosis than their white counterparts, but those diagnosed with osteoporosis have similar fracture risks. The aging of the American population is expected to triple the number of osteoporotic fractures.

The infant’s hips should be off the bed approximately 15° in Bryant’s traction. Bryant’s traction is a form of orthopedic traction. It is mainly used in young children who have fractures of the femur or congenital abnormalities of the hip. Both the patient’s limbs are suspended in the air vertically at a ninety-degree angle from the hips and knees slightly flexed. Over a period of days, the hips are gradually moved outward from the body using a pulley system. The patient’s body provides the counter-traction.

Option A: Absence of pain is not an indication that the traction is working properly. The child’s toes and feet should be warm and pink and the toes should move when touched. Check for these signs of good circulation every four hours the first few days, every four hours after rewrapping the legs, and then whenever the child is fed, changed, or played with.
Option C: The child’s body and the weights are used as tension to keep the end of the femur in the hip socket. The legs are wrapped in adhesive tape attached to a gauze adhesive elastic bandage, then connected to ropes and weights.
Option D: Bryant’s traction is a skin traction, not a skeletal traction. Take the ace wraps (the outer elastic bandage) off the legs. Inspect any skin for redness or irritation. Rewrap the legs with the ace bandages. Start at the feet. Overlap each loop of the wrap halfway. Do not stretch it tight. Stretch with mild tension only (1/3 tight).

Balanced skeletal traction uses pins and screws. A Steinman pin goes through large bones and is used to stabilize large bones such as the femur. For some types of femur fractures, a pin is placed in the child’s broken bone and the pin is connected to the weights. This is called “balanced skeletal traction.” The weights keep the parts of the bone in the proper place so the bone can heal well.

Option B: Only the affected leg is in traction. Weights, ropes and pulleys are used to balance and hold the leg up for best healing. The equipment cradles the leg to help the child relax and feel more comfortable while the ends of the bones are healing together.
Option C: Kirschner wires are used to stabilize small bones such as fingers and toes. The nurses will also check the skin around the pin for these signs: redness, flaking, and blisters. These are signs of skin breakdown and irritation.
Option D: Buck’s traction is not used for fractured hips. For people with hip fractures, traction involves either using tapes (skin traction) or pins (skeletal traction) attached to the injured leg and connected to weights via a pulley. The application of traction before surgery is thought to relieve pain and make the subsequent surgery easier.

Bleeding is a common complication of orthopedic surgery. The blood-collection device should be checked frequently to ensure that the client is not hemorrhaging. Maintain patency of drainage devices when present. Note characteristics of wound drainage. Reduces the risk of infection by preventing the accumulation of blood and secretions in the joint space (medium for bacterial growth). Purulent, non serous, odorous drainage is indicative of infection, and continuous drainage from incision may reflect developing skin tract, which can potentiate the infectious process.

Option B: The client’s pain should be assessed, but this is not life-threatening. Provide comfort measures (frequent repositioning, back rub) and diversional activities. Encourage stress management techniques (progressive relaxation, guided imagery, visualization, meditation). Provide Therapeutic Touch as appropriate. Reduces muscle tension, refocuses attention, promotes a sense of control, and may enhance coping abilities in the management of discomfort or pain, which can persist for an extended period.
Option C: When the client is in less danger, the nutritional status should be assessed. Encourage intake of a balanced diet, including roughage and adequate fluids. Enhances healing and feeling of general well-being. Promotes bowel and bladder function during a period of altered activity.
Option D: An immobilizer is unnecessary in this case. Demonstrate and assist with transfer techniques and use of mobility aids, e.g., trapeze, walker. Facilitates self-care and patient’s independence. Proper transfer techniques prevent shearing abrasions of skin and fall.