IF SYMPTOM’S PERSIST
By DR. JOSE PUJALTE, JR.
“He smote them hip and thigh.”-- The Holy Bible, Old Testament,
Judges XV. 8
Dr. Jose Pujalte Jr.
It should come as no surprise that women, especially the postmenopausal, are not afraid of breaking a bone or two. And why is that? First, they have no idea that they are at the most risk in getting osteoporosis (brittle and weak bones). And second, as a rule, no one walks thinking of slipping or climbing stairs, while thinking of falling.
But the facts are, as people age, bones become less dense. A fall in younger years that would have meant a scratch or a contusion can now easily mean a broken bone. In fact, landing on one’s behind or side is the mechanism for a broken hip.
Risk Factors. As mentioned, age is the first risk factor. But it is not age per se that increases fracture risk. We are talking about inactive individuals who have no interest in getting a sweat now and then. A sedentary lifestyle results in weak muscles, leading in turn to poor balance. Age may also mean bad vision and slower reaction times. The second and third risk factors are sex and heredity. Unfortunately, aside from Caucasians, Asian women are osteoporosis-prone and are therefore potential hip fracture patients. There are medications which, used over time, decrease bone density. Examples are corticosteroids, thyroid replacements, some diuretics and blood thinners. Let’s not forget that some drugs give side-effects of dizziness and the increased chance of losing balance. These are medications for hypertension, coughs and colds, insomnia, depression, and allergies.
Signs and Symptoms. Almost all hip fractures are caused by trauma. It’s heart-breaking to be told that an elderly relative slipped on the floor and was unable to get up.
The symptoms will include:
- Severe pain and swelling at the hip and groin area.
- Bruising or hematoma formation.
- Shortening of the injured extremity.
- Inability to put weight on injured side.
- The foot of the injured side has dropped to the side (externally rotated).
Diagnosis. There is no logic in delaying admission to a hospital. Neglecting a major fracture like that of the hip is almost a crime if people knew of the repercussions.
Keeping a patient lying down (because even trying to sit up is painful) leads to complications such as bedsores, pneumonia, urinary tract infection, wasting of muscles, and depression. A physical examination followed by an X-ray of the pelvis is usually enough to arrive at the diagnosis of a hip fracture.
Treatment. Aggressiveness is warranted in treating hip fractures. However, most patients also have what we call “co-morbidities” -- chronic illnesses like diabetes, hypertension, and heart ischemia that need to be managed before the operation itself. Current expert thinking leaves little room for conservative treatment of broken hips.
Depending on the type of fracture, the condition of the patient, and the delay between injury and operation, the bone doctor has two general approaches. The hip may 1) be fixed with screws and plates or 2) replaced with artificial parts (total or partial hip replacement).
Prevention. It is never too late to treat osteoporosis. Take the extra step of knowing the side or adverse effects of the medications you have been instructed to take. Lessen the chances of slipping by putting rubber mats in the bathroom, removing loose rugs and carpets, mopping food and liquid spills on the floor, and bringing more light in dark areas of the house.
The broken hip need not mean a broken life. Much can be done to prevent it. But should it happen, it won’t be the end of the world.