INTRODUCTION

Intertrochanteric femur fracture affects almost 13 million Americans, and one of the
leading fractures in the Philippines making it the most common form of fracture. An
intertrochanteric hip fracture occurs lower than a femoral neck fracture. Intertrochanteric hip
fractures have a different treatment because they do not have the issues with damage to blood
flow to bone seen with the femoral neck fractures. Because the bone blood flow is usually in tact,
these fractures can usually be repaired, and do not require the hip replacement procedure
described previously. The femur is one of the largest, and strongest bones in the body. The femur
is the thigh bone--it extends from the hip joint down to the knee joint. Because the femur is such a
strong bone, it can take tremendous force to cause a femur fracture. The cause of femur fracture
as stated previously, the femur is a tremendously strong bone--in order for a femur fracture to
occur, either a large force must be applied or something is wrong with the bone. In patients with
normal bone strength, the most common causes of femur fractures include car accidents and falls
from a height.

The femur is the largest and strongest bone and has a good blood supply. Because of this and its
protective surrounding muscle, the shaft requires a large amount of force to fracture. Once a
fracture does occur, this same protective musculature usually is the cause of displacement, which
commonly occurs with femoral shaft fractures.

As with many orthopedic injuries, neurovascular complications and pain management are the
most significant issues in patients who come to the ED. The rich blood supply, when disrupted,
can result in significant bleeding. Open fractures have added potential for infection.

The 3 types of femoral shaft fractures are as follows:

• Type I - Spiral or transverse (most common)

• Type II - Comminuted
• Type III - Open

Associated injuries are common.

History of Past and Present

Past History

There is no illness and fracture after accident happen.

Family History

• Hypertention (Father side)

• Asthma (Father side)

Present History

Few hours PTC

Patient slipped at the bathroom landed on her hips

Physician findings: positive pain on pelvis

• Pelvis AP
• Lumbosacral APL
• For SPI
• Secure Onset

Doctors Order:

Endorsing the case of Rosalia De Leon 85 years old admitted December 13, 2008 with case of
fall

Subjective

• (+) pain on inguinal area

• ( - ) DOB
• Able to seat without difficulty

Objective

• Patient on BST at 14 x 17 Lbs

• Intast Steinmann pin at inguinal area
OBJECTIVES

A. General

It has been universally known that the primary task of health care is patient's care and
concern, as quoted also by the DOH Manual, "The primary function of the nursing
service is the promotion, protection, preservation or restoration of the health of the
people through the provision and delivery of health services and through the regulation
and encouragement of health goods and services." (E.O. 119, Sec. 3).

Fracture of the hip (Intertrochanteric Femur Fracture) is common and may occur at any
age and with changing levels of severity.

This study was undertaken to determine the assessment of Fracture of the hip
(Intertrochanteric Femur Fracture).

B. Specific

Fracture of the hip range from easily treated to life-threatening disorders. Some
disorders required surgical intervention.

Accordingly, the student-nurse who cares for patients with fracture of the hip must
have a clear understanding of its fracture and clinical outcomes. Specifically, this study
was undertaken to answer and understand the the fracture of the hip. Alongside with
this, this study aimed to require the student-nurse to manage symptoms and facilitate
patients' and families' understanding of the fracture. This study also aimed to equip the
student-nurse the appropriate medical and nursing management. In the medical
management, the study focused on medications and laboratory examinations. In the
nursing management, the study tackled the long term objective, the nursing care plan
(NCP) and the discharge plan as this may affect the patient's comfort, functional
independence and self-esteem.

Basically, this case study will help the student-nurse in the teaching of patients of what
they are supposed to know, do and not do based on the needs of patient found by this
study.

This study is also very essential in guiding the patients identify their weaknesses and
limitations, in order to minimize them. Understanding the condition of their sicknesses,
the patient can have opportunity to choose a plan more suited to his self-care ability, as
 this promotes self-dependence and self-reliance, as one of the missions, goals of Alma
Mata (primary health care delivery).

PERSONAL DATA

A 80 year-old female named Rosario Fuentes Regalado, was admitted at Philippine

Orthopedic Center Emergency Room on the 18th of December 2008, placed in a
stretcher. Upon admission, the patient was immediately interviewed and the following
data was acquired; Born in Tondo, Manila on the day of March 27, 1952, Mrs. Regalado
was raised as a Roman Catholic along with her five siblings. Her highest educational
attainment is high school graduate and is presently residing at 1232 Naraso St.
Pandacan Mnla, with her husband and children. She rents the house which they are
staying in and her daily activities include watching TV, cooking and other household
chores. Her average sleeping time is around 2 to 3 hours of continuous sleep at night
and takes 30 minute naps in the afternoons. Her bowel time usually occurs in the
morning and she then bathe herself in cold water afterwards. Oral hygiene was also
being practiced everyday by the patient. Taking down the patient’s family history, it was
noted that the she has a history of Hypertension. She has an allergy in eggs and
chicken and takes Penicillin as her medication. Upon getting the vital signs, the patient
was determined to be hypertensive, afebrile during admission and with normal pulse
rate and respiratory rate. After interviewing the patient, physical examination was done
and the following assessments were gathered; the patient’s physical body built is
slender, she is neat and has smooth skin integrity. Her mental status was alert and
coherent and she was calm in her emotional status. After several examinations, the
attending physician diagnosed the patient with intertrochanteric femur fracture.

DEFINITIONS
Etiology/Causes

• Car accidents
• Fall from height

A hip fracture is a fracture in the proximal end of the femur (the long bone running through the
thigh), near the hip joint.

The term "hip fracture" is commonly used to refer to four different fracture patterns and is often
due to osteoporosis; in the vast majority of cases, a hip fracture is a fragility fracture due to a fall
or minor trauma in someone with weakened osteoporotic bone. Most hip fractures in people with
normal bone are the result of high-energy trauma such as car accidents.

In the Philippines, the mortality following a fractured neck of femur is between 25% and 45%
within one year in patients aged 82, ± 7 years, of which 80% were women.
 AP Hip projection demonstrating an Intertrochanteric fracture

Intertrochanteric fracture denotes a break in which the fracture line is between the greater and
lesser trochanter on the intertrochanteric line. It is the most common type of 'hip fracture' and
prognosis for bony healing is generally good if the patient is otherwise healthy.

MEDICAL AND SURGICAL MANAGEMENT

Surgery for intertrochanteric fracture

 Intertrochanteric hip fracture in a 17-year-old male

Fracture supported by dynamic hip screw

An intertrochanteric fracture, below the neck of the femur, has a good chance of healing.
Treatment involves stabilizing the fracture with a lag screw and plate device to hold the two
fragments in position. A large screw is inserted into the femoral head, crossing through the
fracture; the plate runs down the shaft of the femur, with smaller screws securing it in place.

The fracture typically takes 3-6 months to heal. As it is only common in elderly, removal of the
dynamic hip screw is usually not recommended to avoid unnecessary risk of second operation
and the increased risk of re-fracture after implant removal. The most common cause for hip
fractures in the elderly is osteoporosis; if this is the case, treatment of the osteoporosis can well
reduce the risk of further fracture. Only young patients tend to consider having it removed; the
implant may function as a stress riser, increasing the risk of a break if another accident occurs.

SIGNS AND SYMPTOMS

• SWELLING IN THE AFFECTED AREA

• PAIN IN THE LOCATION OF FRACTURE
• IMMOBILITY
• INFLAMMATION

COMPLICATIONS
General medical complications

Many of patients are unwell before breaking a hip; it is not uncommon for the break to have been
caused by a fall due to some illness, especially in the elderly. Nevertheless, the stress of the
injury, and a likely surgery, does increase the risk of medical illness including heart attack, stroke,
and chest infection.

Blood clots may result. Deep venous thrombosis (DVT) is when the blood in the leg veins clots
and causes pain and swelling. This is very common after hip fracture as the circulation is
stagnant and the blood is hypercoagulable as a response to injury. DVT can occur without
causing symptoms. A pulmonary embolism (PE) occurs when clotted blood from a DVT comes
loose from the leg veins and passes up to the lungs. Circulation to parts of the lungs are cut off
which can be very dangerous. Fatal PE may have an incidence of 2% after hip fracture and may
contribute to illness and mortality in other cases.

Mental confusion is extremely common following a hip fracture. It usually clears completely, but
the disorienting experience of pain, immobility, loss of independence, moving to a strange place,
surgery, and drugs combine to cause or accentuate dementia.

Urinary Tract Infection (UTI) can occur. Patients are immobilized and in bed for many days; they
are frequently catheterised, commonly causing infection.

Prolonged immobilization and difficulty moving make it hard to avoid pressure sores on the
sacrum and heels of patients with hip fractures. Whenever possible, early mobilization is
advocated; otherwise, alternating pressure mattresses should be used.

Drug Study
Drug Name Classification/ Action Adverse Effect Nursing
Indication Consideration
Celecoxib Anti- Inhibits  CNS: dizziness,  monitor
Inflammatory prostaglandin headache, insomia, patient for
synthesis. stroke, signs and
Primarily by  Cx: hypertension, MI, symptoms of
inhibition cyclo peripheral Edema liver toxicity
oxygenase 2  EENT: pharyngitis, cefeloxib
(cox – 2) rhinitis, sinusitis, may be
 GI: abdominal Pain, hepatotoxic.
diarrhea, dyspepsia,  Advice
flatulence, nausea, patient to
 masculoSkeletal: immmidiatly
Backpain report to
prescribe
rash,
unexplained
weight gain
or edema.
 Instruct
patient to
immediately
report to
prescriber
signs of GI
bleeding
such as:
bloody
vomitus,
bloon in
urine, or
stool and
black farry
stool.
 Drug Name Classification/ Action Adverse Reaction Nursing
Indication Consideration
Omeprazole Gastric ulcer and  Chemical  CNS: headache,  Full
reflux oesophagitis Effect: inhibits dizziness, stomach
20 mg OD for 4 -8 acid (proton)  GI: diarrhea  Check for
wks. And 10 mg pump and abnormal pain, rushes
for long term of binds to nausea and vomiting,
reflux hydrogen constipation,
oesophagitis. potassium  Musculoskeletal:
adenosine back pain
triphosphatase  Respiratory: cough
on secretory  Skin: rash
surface of
gastric parietal
cell to block
formation of
gastric acid
 Therapeutic
Effect: relieves
symptoms
caused by
excessive
gastric acid.
Discharge Summary

 Advice the patient to maintain personal hygiene everyday

 Teach the patient proper wound cleaning.

 Advice the relatives to assist patient if patient want to go to bathroom or do things that
can caused fracture again.