Nursing Care for Patients with Hip Fracture who Underwent Closed Reduction with Proximal Femur Nail Fixation and Multiple Comorbidities: A Case Study

Abstract

Older adults tend to have osteopenia and osteoporosis, which increase bone fragility and the risk of fractures. The most effective treatment is internal fixation with an intramedullary nail. Delays of more than four days may lead to avascular necrosis and prolonged hospitalization. Comorbidities in elderly patients further increase the risk of complications. Therefore, operating room nurses must demonstrate competency in preoperative and intraoperative care, possess thorough knowledge of surgical instruments and equipment, and provide effective postoperative care to promote rapid recovery and an early return to normal function. This study investigated the nursing process and care of a patient with a hip fracture who underwent internal fixation with an intramedullary nail and had multiple comorbidities. This study involves an analysis and comparison of a case study with established academic principles, with the findings applied to nursing practice.

A 77-year-old male with a left hip fracture and comorbid hypertension and diabetes mellitus, both well controlled with medication, presented with severe hip pain and inability to walk. X-ray confirmed the fracture. The patient underwent internal fixation with a proximal femoral nail under spinal anesthesia. Perioperative care focused on preventing blood loss, injury, infection, and thromboembolism. No postoperative complications occurred. The patient received physical rehabilitation and was discharged.

This study found that operating room nurses must demonstrate competency in providing nursing care during the preoperative, intraoperative, and postoperative phases of intramedullary nail fixation. In particular, during surgery, nurses must have comprehensive knowledge of the instruments and equipment used for intramedullary nailing, as well as the surgical steps and techniques, to ensure a successful and efficient procedure. Continuous post-discharge care is essential to support rehabilitation and enable patients to return to normal daily activities.