Hip Fracture Patient Guide
The specialists of the Memorial Hermann Hip Fracture Program are dedicated to providing the highest quality care to you and your family member(s). Our evidence based treatment plan is based on standardized protocols resulting in expedited care that appropriately addresses your clinical condition. Our goal is to minimize the time you are in pain, prevent complications commonly caused by lack of mobility, including bed sores, blood clots and pneumonia, and to ensure that you remain an active participant in your care experience. An unexpected incident resulting in a broken bone is a frightening event. We want you to feel confident that you are in excellent hands. Our affiliated physicians, nurses and therapists are experienced, compassionate, and ready to put their specialized skills and training to work in caring for you.
Download the printable Hip Fracture Patient Guide here.
- Cares for thousands of hip fracture patients every year using a variety of surgical and nonsurgical techniques.
- Is led by surgeons who are board certified and fellowship trained.
- Employs a multidisciplinary team approach to caring for you and your family.
- Utilizes resources and specially trained staff dedicated to the care of hip fracture patients.
An important goal of our specialized hip fracture program is an early effective pain control and medical/ surgical intervention, which leads to the best possible result for you. This guide will assist you in understanding what to expect following a hip fracture, including available treatments, possible complications and recovery.
What to Expect
After a hip fracture, patients typically arrive at Memorial Hermann through the Emergency Department or are admitted directly from a nursing or assisted living facility. The diagnosis of a hip fracture usually occurs in the Emergency Department following a review of your medical history and physical examination. You will be evaluated first by the Emergency Department physician and receive a series of blood tests and X-rays. It is important that the physician be advised of any other medical problems you have so that treatment of the hip fracture can begin immediately, including any medications you are taking (especially if you are taking any anticoagulant medication (e.g., Xarelto, Eliquis, Savaysa, Pradaxa, Coumadin, Plavix, etc.)). Information from this examination will be used to help evaluate your overall physical condition and treatment plan. Additional tests may be ordered based upon your individual condition to assess your overall health.
As quickly as possible, an anesthesiologist will evaluate you and take steps in order to manage the pain you will be experiencing, and a hospitalist will continue your treatment by making sure you are medically stable and prepared for surgery. Once the care team is sure that you are stable, a decision concerning the treatment of the fracture can be made and one of the experienced orthopedic surgeons will repair the broken bone.
Introducing Your Healthcare Team
The experienced team at Memorial Hermann will focus specifically on you and your family. Do not be afraid to ask questions. This is a stressful time and we want to make this experience as pleasant as possible. Members of your healthcare team may include:
Orthopedic Surgeon - The physician who will repair your broken hip and oversee your care in
the hospital and during follow-up.
Program Navigator - The navigator is a registered
nurse who will serve as your coordinator of care
throughout your stay. He or she will follow you
throughout your stay and help you prepare for the
transition when you leave the hospital. He or she
also will answer any questions you or your family
Anesthesia Provider - The physician who is
responsible for managing your pain before and
after surgery, as well as administering medications
to keep you asleep and comfortable during your
Hospitalist - A physician who may follow your
medical care during your hospital stay and will
work with your orthopedic surgeon to meet your
care needs, including ensuring you are medically
prepared for surgery.
Cardiologist - If you have a history of heart disease,
a cardiologist may see you prior to your surgery to
assess your condition. The cardiologist may also
assist in managing any heart medications you may
need throughout your hospitalization and recovery.
Case Managers - These team members help to plan
your transition from the hospital to your home, or
other setting of care, and arrange for any additional
equipment and services needed.
Nursing Team (Registered Nurse, Licensed Vocational
Nurse, Patient Care Assistants) - Before, during and
after your surgery, you can expect to meet different
nurses who perform many different jobs. Nurses
will help prepare you for surgery and will be in the
operating room with you throughout your surgery.
After surgery, the nursing team will carry out all
orders given by your team of physicians, as well as
keep you comfortable and safe in the hospital.
Physical Therapist - Your physical therapist is
trained to help you gain strength and motion after
your surgery and will help ensure that you do your
exercises correctly. Your physical therapist will also
help teach you how to properly and safely use
Occupational Therapist - Your occupational
therapist is trained to help you learn to safely and
effectively perform activities of daily living, such as
bathing and dressing. The occupational therapist will
also teach you how to use special equipment, such
as long-handled reachers or shower seats, which you
may need during your recovery.
Dietitian - Your dietitian provides nutritional
counseling to help you make healthy choices about
the foods you eat and helps you understand the
connection between diet and healing.
Other team members that you may meet include
pharmacists, lab and X-ray technicians, patient
transporters and respiratory therapists.
About Hip Fractures
The hip is one of your body’s largest weight-bearing joints. It consists of two main parts: a ball (femoral head) at the top of your thighbone (femur) and the rounded socket in your pelvis into which the femoral head fits.
The top of your femur is categorized into four main
parts: the subtrochanteric region near the bottom
of the hip joint, the intertrochanteric region in the
middle of the joint, the greater trochanter at the top
of the joint, and the femoral neck that connects the
femur to the femoral head. Hip fractures occur in
three main areas: femoral neck, intertrochanteric
region, and subtrochanteric region.
The type of surgery you have depends largely on
where your fracture has occurred. The following
describes these different types of hip fractures and
some common procedures to repair them.
Femoral Neck Fracture
What is it?
In this type of fracture, the ball is essentially
broken off of the femur, which is also known as the
thighbone. With a femoral neck fracture, there is a
chance that the blood supply to the ball of the hip
will be interrupted. In most cases, this will need to
be fixed in surgery.
How is it fixed?
Depending on how stable the fracture is will depend
on what type of treatment is needed. Two of the
more common treatments are: hemiarthroplasty
(half of a hip replacement), or metal pins or screws.
A third option may be a total hip replacement.
- Hemiarthroplasty – This is when the broken ball
of the hip is replaced with an artificial metal ball.
In this case, there is nothing wrong with the
socket and it is left alone.
- Metal pins or screws – This treatment is used
when the fracture is more stable. The pins, or
screws, are used to keep the fracture stable.
- Total Hip Replacement – This treatment may be
necessary if you also have some arthritis in your
hip. Both the ball and the socket would
Intertrochanteric Hip Fracture
What is it?
An intertrochanteric hip fracture may be described as
a break through the top of the femur, or thighbone.
This type of fracture occurs just below the neck of
the femur. In most cases, this fracture will not be
stable and will need to be fixed in surgery.
How is it fixed?
The way this fracture is fixed depends on the stability
of the fracture and also the surgical recommendation
of the surgeon fixing the fracture. Two of the more
common ways to fix this fracture include:
- A metal rod or nail – A long metal rod or nail is
inserted into the canal of the bone. At the top of
the nail, or rod, is a place for a screw. This screw
will help keep the bone compressed and in place
as the bone heals.
- A metal compression screw – A plate is inserted
along the side of the femur and several screws are
used to hold the fracture in place. One main screw
will allow the fractured bone to compress as the
bone begins to heal.
Subtrochanteric Hip Fracture
What is it?
This fracture can be described as a break across the
shaft of the femur. These fractures usually are not
stable and require surgery to stabilize the fracture.
How is it fixed?
There are several different ways that this fracture
can be fixed. The way it is fixed depends on the
stability of the fracture and also the preference of the
surgeon. One of the more common ways to fix these
- A metal rod or nail – A long metal rod or nail is
inserted in to the canal of the bone. At the top of
the nail, or rod, is a place for a screw. This screw
will help keep the bone compressed and in place
as the bone heals.
Other Fragility Fractures
The pelvis is the bony ring structure that attaches
your lower extremities to the spine. It also holds the
cup portion of the hip joint called the acetabulum.
Both the ring and acetabulum may break when you
experience a fracture.
Pelvic ring fractures may be stable, which means
that the fracture pieces will not move, or unstable,
which means the pieces will be able to move and
cause pain and heal in a crooked position. The
treatment depends on the fracture stability. The
stable fracture is able to withstand the forces of
weight bearing and you will be mobilized. The
unstable fracture requires stabilization of the
fragments by long screws or plates inserted through
small incisions using a special X-ray machine that
allows your surgeon to see what is happening.
Fractures of the proximal humerus involve your
shoulder joint. Because the shoulder joint has a
great range of motion, the need for an exact
reduction is not necessary as you regain all the
motion you need for normal function with nonoperative
care. However, in situations where the
fracture is severely displaced, operative treatment
will be recommended to assure healing and
function. These fractures are usually fixed with metal
plates and screws. However, if the surface of the
joint is involved or the number of pieces is excessive,
replacement of the shoulder may be performed.
Many people have had a hip or knee replacement
done for the treatment of their arthritis. With weaker
bone there is a potential for the bone to fracture
about the implant. As most joint replacements are
done in the hip and knee, it is very common for the
femur to be the site of these fractures. Based on the
amount of involvement of bone near the prosthesis
and the need for you to be mobilized, the treatment
of theses fractures ranges from metal plate or nail
fixation of the fracture to redoing the joint replacement.
In the Hospital
From the moment you arrive at the hospital until
after surgery, you may not be allowed to eat or drink.
This will reduce the risk of complications during
your surgical procedure. An IV will be inserted to
keep you hydrated, and you will be given antibiotics
to help prevent infection. For your safety, you will
remain in bed until after surgery. A urinary catheter
may be inserted to drain your bladder. In order to
prevent blood clots, you may be placed in foot or leg
pumps and compression stockings. To help prevent
pneumonia, you may be given a small device called
an incentive spirometer to help improve your deep
breathing. After surgery, you will be given a
medication to help in the prevention of blood clots,
which will continue for a few weeks after the surgery.
Managing Your Pain
Managing your pain safely and effectively is
important to us. A fractured bone can be very
painful, especially before surgery. There are many
new pain management techniques used by the
Memorial Hermann Hip Fracture Program to
manage your pain and make you as comfortable
Your healthcare team will do everything possible to
decrease your discomfort using medications and
other techniques; however, you should not expect
to be totally pain free.
If you are having pain, please report it to your
caregiver immediately. Do not wait until your pain
is unbearable before asking for pain medications.
Treating pain early is easier than treating it after it
has become severe. You can help your healthcare
team "measure" your pain. While you are recovering,
your healthcare team will often ask you to rate your
pain on a scale from 0 to 10. Using this scale to
measure your pain helps the team know how well
your treatment is working. Our goal is to not let your
pain reach a level above 5-6 on the pain scale.
Managing a Safe Environment
During your hospital stay, we want to ensure your
surroundings are safe and prevent any activity that
could increase your risk of re-injury, including falling.
A yellow bracelet will be placed on your wrist to
alert the staff and members of your family that you
are at risk for a fall. Always use your call light for
assistance to get out of bed with hospital staff, not
family. Further safety measures may include the use
of bed alarm, chair alarm, safety belt and frequent
checks by nursing staff to ensure that special
attention is provided for your needs and welfare.
Managing a Quiet Environment
We will make every effort to limit nighttime
interruptions as much as possible. Please
understand that we will be checking on you during
the night to make sure you are okay. Sometimes it
will be necessary to wake you up during the early
morning hours for routine checks and blood tests
that your physician has ordered. These normal
procedures are to ensure that your physician has
the results available as early as possible.
Managing Possible Complications
Complications can occur after a hip fracture and,
generally, are related to immobilization. The most
common complications are:
- pressure ulcers (bed sores)
- blood clots or thrombophlebitis
- mental confusion (delirium)
- urinary tract infections (UTIs)
Getting out of bed and moving can reduce the risk
of developing these complications. If an operation
is necessary to stabilize your fracture, your healthcare
team will assist you with getting up as soon
as possible to help reduce the overall risk of
developing these complications.
Bed rest can increase the risk of developing
pneumonia in older patients. If anesthesia is
required for surgery, the risk is even greater. After
any injury that requires bed rest, you will need to do
several things to keep your lungs working their best.
Your nurse will coach you to take deep breaths and
cough frequently. Getting out of bed, even upright
in a chair, allows the lungs to work much better. As
soon as possible, you will be allowed to sit in
The incentive spirometer is a small device that
measures how hard you are breathing and gives
you a tool to improve your deep breathing. If you
have any other lung disease, such as asthma, the
respiratory therapist may also use medications that
are given through breathing treatments to help open
the air pockets in the lungs.
Pressure Ulcers (Bed Sores)
Hip fractures cause pain when you move, even in
bed. As a result, you stop moving around to shift
your weight from time to time as you normally would.
If something prevents you from shifting and the
pressure stays constant in one area, that area of
skin may eventually become damaged due to lack
of blood flow. This damage is called a pressure ulcer
or bed sore.
The best treatment is to prevent bed sores in the
first place. Nurses routinely assist to move patients
in bed every few hours to make sure the skin is not
getting too much pressure in one area. The best way
to prevent pressure ulcers is to get you out of bed
and moving when possible.
Blood clots, sometimes called deep venous
thrombosis (DVT), can result from bed rest and
inactivity. DVT occurs when blood clots form in the
large veins of the leg. This may cause the leg to
swell and become warm to the touch and painful. If
the blood clots break apart, they can travel to the
lungs and cut off the blood supply to a portion of
the lungs. This is a life-threatening condition called
pulmonary embolism. (Pulmonary means lung,
and embolism refers to a fragment of something
traveling through the blood vessels.)
There are many ways to reduce the risk of DVT, but
the most effective is getting you moving as soon as
possible. Two other commonly used preventative
- Leg pumps or foot pumps with pressure stockings
to keep the blood in the legs moving
- Medications that thin the blood and prevent blood
clots from forming
Mental Confusion (Delirium)
Aging adults who suffer a hip fracture and go to
the hospital are under a lot of stress. Unfamiliar
surroundings, pain medications, and the stress
of the injury can lead to changes in a patient’s
behavior. This sometimes seems to get worse at
night and it can be very frightening to both patients
and their families. Fortunately, it is almost always
The best treatment for mental confusion is usually
to get patients moving and out of the hospital,
and to avoid the use of narcotic pain medication.
Familiar surroundings, familiar faces, and activity
are the best treatments. Medications are used when
necessary. Again, this is usually temporary and will
resolve in time.
Studies have shown that many older patients can be
malnourished and that taking a protein supplement
with calcium can help avoid complications. Protein,
vitamin C, and vitamin D aid in the healing process
of your cells, and calcium is needed to build and
strengthen bone. You will be given this supplement
to drink while in the hospital. Our dietitian will assist
you in planning menu choices to ensure you have
the proper diet.
Osteoporosis is the thinning of bone tissue and loss
of bone density over time. This occurs when the
body fails to form enough new bone, when too much
old bone is reabsorbed by the body, or both. Some
risk factors include:
- family history of osteoporosis
- eating disorders
- low body weight, too little calcium in the diet
- heavy alcohol consumption
- medications such as steroids and anticonvulsants
Unfortunately, there are no early symptoms of
osteoporosis. Fractures of the vertebrae, wrists, or
hips may be your first clue you have osteoporosis.
Bone pain, tenderness, loss of height and stooped
posture are late symptoms.
There are several tests that can be performed to
evaluate for osteoporosis such as a DEXA scan,
X-rays or measurement of the calcium in your urine.
As for treatment options, there are several ways to
handle this disease. Physical exercise can reduce
the chance of fractures associated with osteoporosis.
Weight-bearing exercises such as balancing exercises,
stationary biking, rowing machines, walking and
jogging are some of the examples. A diet that
includes an adequate amount of calcium, vitamin
D, and protein should be maintained. Foods rich
in calcium include milk, yogurt, cheese and salmon.
If you have been told you have osteoporosis during
this hospitalization it will be important to have
follow-up care for this condition. Our healthcare
team will assist you with this follow-up.
Taking narcotics for pain management or other
medications may result in constipation. It is highly
recommended to increase fluid intake, eat foods
high in fiber, and increase mobility. Intake of a bran
mixture of 3 cups unsweetened apple sauce, 2 cups
coarse wheat bran, and 1½ cups unsweetened
prune juice significantly reduces laxative use. Other
sources of fiber are fruits, vegetables or nuts. Your
physician may order medications to help with
constipation if high fluid intake and a high fiber
diet are still not helping.
Hip surgery can affect your ability to move around,
as well as normal daily activities. This is likely one
of the most frightening and painful experiences that
you or your family member has experienced. It is
unplanned and usually takes everyone off guard.
In addition to your medical team of physicians and
nurses and many others, your therapists will assist
you during your hospital stay and return you to the
highest level of function possible.
Our goals for you/your family member are to:
- Move – with the help of therapy – as soon as
medically stable and appropriate as determined
by your orthopedic surgeon – likely on the day of
surgery or within 24 hours of your surgery.
- Have adequate and consistent pain management
to participate at the highest functional level
possible. You will not be pain free, but the more
you move the better your hip will feel.
- Be able to safely get up to the edge of your bed,
get to a bedside chair and a bedside commode.
- To be able to walk with the assistance of a walker
(or other equipment as appropriate).
- Perform your activities of daily living, such as
grooming, dressing, toileting and showering.
- For those patients with hip replacements,
communicate understanding of hip precautions
and be able to integrate them into activities of
Participation in Therapy
In order for you to return to your highest level of
function as quickly as possible, it is imperative that
you have adequate pain control to be able to move
around throughout the day. Typically if you do not
move, you may not hurt too badly and not request
or get pain medicines. When you may have to get
up to the bathroom or participate in therapy, the
pain increases quickly and intensely. The solution to
this problem is to have pain well controlled throughout
the day so that you are able to handle a small
amount of pain during activities, without needing
heavier doses of pain medications. This means
taking medication consistently throughout the day
and night that will allow you to move. This ability
to move also helps to alleviate other complications
previously described in this book.
Depending on the type of surgery you have to repair
your hip and your surgeon’s preference, the amount
of weight you can put on that leg may be limited.
Weight bearing as tolerated - You can put as much
weight on your leg as you can tolerate.
- Partial weight bearing - Less than 50 percent of
your weight on your operative leg.
- Touch down weight bearing - Only allowed to put
your toes down on operative leg to balance; VERY
minimal weight bearing.
- Non-weight bearing - Not able to bear any weight
on operative leg.
Limit Leg Lifting
Do not prop or lift leg up past 90 degrees at affected hip.
Some activities such as cutting toenails or shaving legs will require assistance from others.
Keep legs apart at all times. do not cross legs whether standing, sitting or lying down. Use pillow to keep legs apart in bed.
No Internal Rotation
Do not twist affected leg inward. Keep foot pointed forward or out to side. This also applies when lying in bed. May use towel roll to keep leg from rolling inward.
Total and Partial Hip Precautions Only
No bending of your hip more than 90 degrees.
Knee should be below hip and shoulders behind
hip at all times.
- No crossing the middle of your body with
- No turning the operative leg inwards.
No toes inward.
Your physical therapist will begin with personalized exercises with you to not only help move the hip, but
also to increase your strength and range of motion in
your hip. You should be performing the exercises given to you twice a day.
Preventing Future Injury
After you recover from a fracture the last thing you
want to do is endure another injury, and falls are the
most common way to re-injure a hip. Falls can be
caused by loss of balance, medication side effects,
poor vision, impaired mobility, or environmental
You can prevent a fall by following the below
- Make sure all handrails are not broken and are
- Both sides of the steps should have handrails.
Floors and Rugs
- Remove rugs and runners that tend to slide
- Secure all rugs, including area rugs, to the floor
with tacks, non-skid pads or double-sided tape.
- Ensure all floor boards are even.
- Use non-skid floor wax.
- Use non-skid mats in the tub and shower and on
the bathroom floor.
- Add a bath or shower seat if you are unstable
- Never use a towel rack or soap dispenser/dish for
support as these can easily come loose, causing
you to fall.
- Attach grab bars to structural supports in the wall
or install bars specifically designed to attach to
the sides of the bathtub.
- Remove soap buildup in tub or shower on a
- Items that you use frequently, such as dishes,
should be easy to reach.
- Ensure that your step stool has a handrail that you
can hold when climbing on the top step, and all
screws and braces are tightened and secured.
- Discard stools with broken parts.
- Use maximum wattage bulb allowed by the fixture
(if you’re unsure, do not exceed 60 watts).
- Place nightlights in hallways, bedrooms,
bathrooms, and stairways.
- Install light switches at the top and bottom
- Place a lamp (and telephone) near your bed.
- Keep lighting uniform in each room and add
lighting to dark spaces.
- Keep a working flashlight in a convenient location
at the bottom and top of stairwells and close to
your bed in case electric power goes out.
- Arrange furniture so that outlets are available
for lamps and electric appliances without use of
- Check whether hallways and rooms have
obstacles to safe movement.
- Move newspapers, boxes, electrical and phone
cords, plants and furniture out of traffic areas.
- Store clothing, bed coverings, and other
household items where you can reach them
- Keep a telephone close to your bed for emergencies.
Outside of Your Home
- Repair holes, uneven joints on walkways.
- Be cautious of any surfaces that may be slippery.
Arrange to have wet leaves removed from stairs
- Make sure outside lighting is working in entryways
and other walk areas.
- Check that handrails are not broken and are
securely fastened. Both sides of steps should
Other Essential Steps for Protecting
Yourself Against a Fall
- Assess your home to identify fall hazards and
make the necessary changes to prevent them.
- Ask your physician or pharmacist about the
effects of the prescription and non-prescription
medications you are taking. Some medications
can cause dizziness or lightheadedness that can
lead to falls. As people age, the effects of
medications may change.
- Have your eyes checked every year. Vision
problems can cause falls.
- Check with your physician about appropriate
physical activity and exercise. Stay as physically
active as you can. Exercise helps to prevent falls,
especially activities that enhance balance and
- Be careful to wear shoes that do not cause you
to trip. The soles should be non-slip and not
Upon admission, our multidisciplinary team will
make recommendations regarding your discharge
plan and present you with the options appropriate
for your specific situation (e.g., directly home, to a
skilled nursing facility or inpatient rehabilitation
facility). Case management will be involved in
assisting you on the selection of an appropriate
provider and determining if your insurance will
cover the expense of that transition.
After this type of injury, you may need to continue
care at another facility before returning home. Once
our therapists complete your initial evaluation, your
multidisciplinary care team will utilize this information
along with your preferences to recommend the
most appropriate next level of care based upon your
personalized clinical needs. This information will
be shared with you and your family, your physician,
and the case management team. It is important to
note that due to the time it may take to arrange for
these services, that you and/or your family begin the
process of identifying your preferred facility as soon
as possible following your admission to the hospital.
Our case management team is available to assist
you in selecting a high-quality post-hospital provider
from our network of post-acute care partners.
Depending on your needs, you will be discharged
to one of the following levels of care:
- Home - You may be able to return to your home
with the assistance of home health services.
These services will likely include nursing and
therapy care provided to you several times a
week in the comfort of your own home. In
addition, you may qualify for enrollment in
Memorial Hermann’s home-based virtual care
management program, My Health Advocate.
- Sahara Home Health
- Brookdale Health Care
- Kindred (Gentiva)
- Texas Home Health
- Skilled Nursing Facility (SNF) - You may need a
higher level of care and therefore be discharged
to a SNF where you will have around the clock
nursing care and daily therapy services depending
on your needs. Medicare and many insurance
companies require a 3-day hospital stay to
generate coverage for a SNF stay.
- Woodlands Healthcare Center
- Park Manor Conroe
- Broadmoor at Creekside
- Fallcreek Rehab
- Park Manor Humble
- Garden Terrace
- Brookdale Galleria
- Tuscany Village
- Park Manor Southbelt
- Courtyards of Pasadena
- Westchase Health and Rehab
- University Place
- The Crescent
- Memorial City Health and Rehab
- Legend Oaks Katy
- Inpatient Rehab: You may qualify for an Inpatient
Rehabilitation Facility (IRF) where you would
receive a more aggressive level of therapy. You
must meet admission criteria that includes
requiring 24-hour nursing care and being able
to tolerate 3 hours of therapy a day.
Call the office if you develop any of the following:
- Persistent bleeding.
- Persistent nausea/vomiting.
- Numbness, tingling, discoloration, loss of sensation of affected extremity.
- Fever greater than 100.4 degrees fahrenheit/chills/dizziness.
- Redness, swelling, or pus in surgical incision.
- Pain, swelling, or redness in calf.
- If your cast or splint becomes wet or too tight.
- Any unusual symptom that doesn’t seem right.
Resume diet as tolerated. Drink plenty of water and
- Weight bearing.
- Weight bearing as tolerated (WBAT): You can walk
on the injured limb with as much weight as you
like. If it hurts too much, then try partial weight
bearing and slowly increase it to full weight.
- Touchdown bearing: you can rest your foot on the
floor so you don’t have to hold it in the air. But
now weight can actually be placed on the limb.
- Elevate injured limb ABOVE the heart to help
- Use assistive devices, such as a wheelchair,
walker, crutches, or cane as instructed.
- Pump your ankles up and down at least 20 times
per hour to help prevent blood clots
- In most circumstances, when you leave the hospital,
you can start to shower and let water run over the
incisions. Do not submerge or soak the wounds in
water such as a bath or swimming pool.
- DO NOT touch or scratch your incision.
- DO NOT put ointments of any kind on your incision.
Place a towel over the splint/extremity. Apply a large
bag of ice to the operative site for 30 to 45 minutes
every 2-3 hours. Continue to ice as needed to control
pain and swelling as you become more active.
Pain is normal and expected after surgery. You will
not be pain free. Take pain pills only as prescribed
for as long as needed. Pain medication can cause
constipation. Drink plenty of fluids and eat high
fiber foods. If needed, the following over-the-counter
remedies are recommended: Senakot, Colace and
Milk of Magnesia.
Have a responsible adult with you for approximately 24
hours following surgery. We recommend that you do
not make any critical decisions, sign any legal papers
or operate any dangerous equipment for 24 hours following
surgery or while taking prescription medicines.
Please bring a list of all current prescriptions to each
follow-up appointment. If the patient is not able to
communicate or make medical decisions, please
have a family member accompany him or her.
Typical follow-up is as follows:
- 2-3 weeks: suture removal, wound check and pain
- 6-8 weeks: X-rays for bone healing, range of
motion and pain assessment
- 10-12 weeks and every 2-3 months thereafter
until healed for X-rays to assess healing, range of
motion and function.
Interpreter services, including American Sign
Language, are available 24 hours a day to provide or
arrange for interpreters to assist patients and staff
members. If you require an interpreter, please ask a
staff member to arrange one for you.
Access: You have the right to review or receive
a copy of your medical information, with limited
exceptions. You may request that we provide copies
in a format other than photocopies. We will use the
format you requested unless we cannot practicably
do so. If we maintain your medical information in an
electronic format, you may request and we shall
provide you with the requested information in
an electronic format. You must make a request
in writing to obtain access to your medical
information. You may obtain a form to request
access or a copy of your medical information from
memorialhermann.org webpage and mail the
completed form to Memorial Hermann Release of
Information, 7737 SWF C94, Houston, Texas 77074
or the Release of Information Department, located
at the facility where you obtain your medical care.
There is a charge for a copy of your medical
The Memorial Hermann Release of Information department
is dedicated to processing your requests
for patient-protected health information in a timely
manner, while maintaining patient confidentiality.
Hours of operation are Monday through Friday from
8 a.m. to 4:30 p.m. For your convenience, we have
one central mailing address for all Memorial Hermann
hospitals and outpatient centers:
Memorial Hermann Release of Information
7737 SWF C94
Houston, TX 77074
Additional information can be found online by
accessing the Patient & Caregivers tab at
Injury that causes a change in your daily activities
brings with it paperwork that must be completed
within a timely manner. You are responsible for
obtaining paperwork and getting it to our office
to be completed. While we make every attempt to
complete paperwork as quickly as possible, we
do require 5 business days to do so. It is not
possible to complete paperwork during a clinic
visit. All paperwork requires that the patient fill
out a portion that includes a signed release of
information statement. If the paperwork is faxed
directly to the office, your legal name and birth date
must be included. It is also a good idea to call
the office to make sure that faxed paperwork was
- Work/School excuse: These are provided during
clinic visits upon request.
- FMLA: This will come from your employer. It may
be for the patient or a family member who will be
a care provider. If it is faxed directly to the office,
be sure to clearly indicate the patient's full name
and date of birth on the form.
- Disability: Paperwork will come from your
insurance company. If faxed to the office, be sure
to clearly indicate the patient’s full name and
date of birth.
- Medicaid: If you do not already have a Medicaid
member number, you must apply through the Social
Security office. If you will require transportation
assistance through Medicaid, you must apply for
it 5 days prior to the needed date.
- Workers' Compensation: This is initiated through
your employer. You will be provided a case number
and be assigned a case worker. Our office will
work closely with you and your caseworker during
your treatment and follow-up.
How to rate your pain: You will be asked to rate your
pain using the 1 to 10 pain scale, with one being no
pain to 10 being the worst pain imaginable. You will
also be asked to qualify your pain, using terms like
sharp, dull, throbbing, burning or aching. Please note
that you will not be pain-free. The goal is to make the
pain tolerable. Please refer to "Wong-Baker Faces
Pain Rating Scale" on page 10.
Prescription Pain Medicine: Hydrocodone is the
most common narcotic medication used for surgical
pain. Oxycodone is more rarely used for severe pain.
Both hydrocodone and oxycodone cannot be called
into your pharmacy; they require a special written
prescription. You may be prescribed these narcotic
pain medicines for up to 6 – 12 weeks, depending
on your pain requirements. If more potent pain
medicines are required during these initial weeks or
if pain medicine is required beyond 12 weeks, you
may be referred to another physician who specializes
in pain management. Never take more of these
medicines than prescribed because you are having
more pain. If your pain is not rating a 4 or lower on
a scale of 1-10 and you are elevating, resting and
icing, call the nurse. Do not attempt to drive or
operate machinery while taking narcotic pain
Non-narcotic Pain Control
Neurontin (gabapentin): This prescription
medicine is used to treat nerve pain, which is a
burning pain that some patients experience after
surgery. Gabapentin needs to be “stepped up”
and "stepped down,” meaning that you gradually
increase your dose over time and gradually
decrease your dose when you stop taking it.
For elderly patients, you may start at a lower dose, which is 100mg three times a day. Generally, you will start with 300 mg the first day,
then 300 mg twice a day on day 2, and 300 mg
three times a day until you stop taking it. When
you are stopping this medication, you will go to two
times a day the first day, then 300 mg on day two,
and none the following day. The dose of gabapentin
may be increased by your physician. Keep in mind
that this medication must be taken as directed, and
cannot be taken on an as-needed basis.
Ultram (tramadol): This prescription medication
may be prescribed when you are transitioning from
narcotic pain medicine to over-the-counter pain
medicine or other narcotic medicines. It also is prescribed in addition to other medicines, working synergistically to reduce your pain. Do not take
tramadol if you have a history of seizures, and
notify your physician if you are taking prescription
medications for depression, as this medicine may
not be appropriate for you.
Tylenol (acetaminophen): This medication is
available over the counter. It is non-narcotic and not
sedating. It is very effective, particularly in elderly
patients. You can take it every 6 hours, but do not
take more than 4 grams per day in total.
Blood Clot Prevention
- For the first 3-4 weeks after surgery, you likely will
take medicine to help prevent blood clots. These
include aspirin, Lovenox (enoxaparin), Coumadin
(warfarin) and a few others.
- Do not remain in the same position all day; walk
as much as possible. If you are having difficulty
walking, at least move from bed to chair 2-3 times
- Actively pump your knees (straight and bent) and
ankle (up and down) to help circulate blood flow
and prevent blood clots.
Bone Health Medications
- Calcium: Take 1,500 mg of calcium a day,
divided into three 500 mg doses taken with meals
- Vitamin D3 (cholecalciferol): Take 1,000-2,000
international units per day (over-the-counter
- Vitamin D2 (ergocalciferol): You may be
prescribed ergocalciferol if there is concern for
a significant vitamin D level. If so, you will take
50,000 units ergocalciferol for about 2 months, in
addition to daily over-the-counter calcium-vitamin D.
Important Information About Prescription Refills
- Notify your physician or his assistant as soon as
possible when you need a refill. It may take up to
24 hours for your call to be returned.
- If you call after 5 p.m. on weekdays, do not expect
a callback until the next work day. If you call after
5 p.m. on Friday, do not expect a callback until
Monday morning. If you leave a message, you
will be asked to speak slowly and spell your last
name, and leave your date of birth and phone
number. To expedite your request, leave the name
and phone number of the pharmacy you choose.
- Ultimately, it is your physician’s decision whether to
authorize a refill of pain medication. It is our goal
to gradually decrease the strength and amount of
pain medicine you take. This may take time, and
your pain may increase for a short time when you
become more active. This is normal and expected.
How can I help my bones heal?
- Avoid anti-inflammatory medicines: Studies
suggest that ibuprofen and similar products, like
Aleve, may inhibit bone growth, which may delay
- Avoid caffeine: Caffeine increases the rate of
calcium loss through urine, decreasing the
amount that is available in your blood for
- Do not smoke: Patients who smoke experience
a longer healing time and are at higher risk of
nonunion (non-healing of the bone), wound
problems, infection and chronic pain. Smoking
(nicotine) causes vasoconstriction (blood vessels
get narrower,) decreasing blood flow to the healing
bones. Nicotine use is also associated with
- Avoid alcohol: Alcohol consumption interferes
with the formation of new bone cells and should
not be taken while using pain medication.
You may be given a prescription for physical
therapy. You will take this prescription to the
physical therapist of your choice. It is best to
choose one close to home, as you will go several
times a week. Let your therapist know when you
have a clinic appointment, so you can bring
progress notes with you.
You may be given an instruction sheet with home
exercises. While you are at home recovering from
surgery, your homework is to work on your ankle.
You have a lot of time. The more you work on the
injury, the better it will get.
Going Back to Work
Returning to work depends on what kind of fracture
you have and what kind of work you do. Some jobs
require that you return to work with no restrictions,
while others will allow you to return to work with
provisions that allow you to continue healing while
on the job. We will provide you with documentation
explaining what you can or cannot do while on the job,
and it will be up to your employer to accommodate
your needs or have you remain off work until you
are able to return to full duty without restrictions.
For safety reasons, it is not appropriate to return to
work while regularly taking narcotic pain medication.
Dentist and Antibiotics
It is only necessary to pre-medicate with antibiotics
for the dentist if you have had a joint replacement.
If you have had a joint replaced and are visiting the
dentist, please call the office several days before
your appointment so that your physicians can
decide if you need to be treated and we can get it
called into the pharmacy.
Travel and Hardware
You do not need any special identification to show
at airport security relating to your hardware. In the
past, identification cards were widely accepted, but
today they are not. If you should set off the alarm,
notify security officers where you had surgery.
Most patients maneuver through airports with no
After this type of injury you will need an assistive
device to help you walk, such as a rolling walker,
a 3-in-1 commode, or tub transfer bench. For your
safety, if you are walking with an assistive device
in the home you should always be sitting for your
bath/showers. Your needs will dramatically change
between now and the time you go home. Your team
will help you determine which equipment is most
appropriate for you. The facility where you are discharged home from is responsible for ensuring you have the necessary equipment upon your discharge. Unfortunately, this bathroom equipment is not USUALLY covered by your insurance, so we recommend you look online for equipment or check local stores. You may also check with local churches or organizations that may have medical equipment that you can obtain at significantly reduced price.
If you or a family member has questions during your treatment by your healthcare team, do not hesitate to let
us know. We are here to provide you the best care possible.
Additionally, below are some answers to frequently asked questions related to your recovery.
Frequently Asked Questions
Can I be as active as I was before?
After a hip fracture, you may not be able to move
around as easily as you did before. But with some
effort and a positive attitude, you can get back to
doing many things you enjoy.
When will the pain in my hip stop?
Your hip will likely be sore for several weeks after
surgery, but this pain can be managed with
medicine. The pain should also lessen with time
and proper exercise. If you are still very sore even
with the medicine that you’ve been prescribed or
given, or if the pain seems to be getting worse, talk
to your doctor as soon as possible.
Why do I need to begin doing exercises right after
Exercise is needed for proper healing. Some
exercises help prevent blood clots, while others build
strength to help you get out of bed and get moving.
When can I go home?
This often depends on your health and how well
you can get around. Our goal is to have you ready
to leave the hospital in 3-4 days, but you may need
to go to a skilled nursing facility or other site for an
additional week or two before returning home.
How long before I can use the bathroom on
Your catheter is removed once you can move to the
bathroom. This is often a day or two after surgery.
A therapist will teach you how to get on and off the
When will I walk again?
With the help of a physical therapist, you will begin
learning how to walk again before you leave the
hospital. Your healthcare provider may restrict your
amount of weight-bearing activities after surgery,
depending on the location of the fracture, as well as
the surgery type. For several months following your
surgery, you may need to continue physical therapy
and walking with a cane or walker.
How long will it be before I can stop using my
walker or crutches?
You need to use your walking aids until your healthcare
team says you can stop. Most people use them
for at least 6 weeks after surgery.
Will I need physical therapy once I’m home?
You will need to walk and exercise, but needing
physical therapy will depend on how well you
recover on your own. Your healthcare team will tell
you whether you should have physical therapy after
you leave the hospital.
Do I need to tell anyone other than my family doctor
about my hip fracture and surgical repair?
Be sure to tell your dentist or other physicians that
care for you that you have had surgery for a fractured
hip. You may need medicine to prevent infection
before having dental or other medical work done.
How soon can I drive?
To drive safely, your strength and reflexes need to
be as good as before your hip fracture. Remember,
if you can’t safely make an emergency stop, your
insurance will not cover you if you have an accident.
Usually, you won’t be allowed to drive for at least
2 to 3 months after your surgery. However, your
physician will let you know when you are able to
When can I travel?
You should not travel long distances in the first 3
months after surgery. This is because sitting for
too long while travelling increases the risk of blood
clots. Your healthcare team will give you advice on
traveling. Be sure to tell your team about any travel
plans you have after surgery. Tell your surgeon
about any unplanned travel you have to do.
When can I go back to work?
This will depend on how well and how quickly you
heal and the kind of work you do. For example, a
person with a desk job will likely be able to go back
to work sooner than someone who lifts or pushes
heavy objects. Your surgeon will tell you when it is
safe to return to the type of work you do.