Broken hip, not a candidate for surgery. What should we expect?

My 89 y/o Mom had an acetabular hip fracture. She has severe dementia, and surgery was not an option. They treated her pain with Tramadol. She was in rehab for 28 days, then home to a transfer chair and indwelling catheter, and visiting therapists, nurses, and aides. I'm happy to say that within 60 days, the hip fracture had healed enough for her to be weight bearing, the catheter came out, and she is now walking without assistance, albeit with a little "hitch in her get-along." But not in any pain anymore, that was tough watching her deal with pain and not remembering or understanding why. This may not be the type of fracture your MIL had, but in case it is, that's our story. And she was under the care of an orthopedist the entire time.

Hoping MIL has had surgery by now. Horrifying to picture any scenario where an 89 year old would be left to suffer in such pain. I thought those days were gone. Back in the day...2006...my mom broke her hip and was taken to the hospital. I believe her orthopedic surgeon who examined her went out of town at some point, expecting her I guess to just lie there and somehow heal on her own. She was in excruciating pain literally with every movement she made. Even the nurses were horrified and subtly encouraged me to take action. So I told the nurses I wanted to talk to the doctor ASAP. To this day I still remember standing at the nurse's station taking that call. I pretty much reamed him out and in short order another orthopedic surgeon was assigned, my mom had the surgery, and went on to live a reasonably good life until she died 3 months ago. My mom was 80 at the time, I understand, "younger" than the MIL. But I can't believe surgical procedures haven't advanced in 14 years to the point where unless the MIL is already at death's door she wouldn't survive and benefit from the surgery. If you haven't already, please insist on a second opinion. Best wishes.

She needs to see a bone surgeon. Imho, I don't how a broken hip is supposed to heal without surgery.

Usually, surgeries of this kind are done under general anesthesia. See if she is a candidate for spinal anesthesia which is easier on lungs, kidneys, and heart.

If she has osteoporosis, the hip may not mend. Then, she will be most likely in a bed or wheelchair for the rest of her life. Please make sure they are stabilizing her hip in some way and that she gets pain medication. If her usual doctor feels unable to deal with her pain, ask for a pain specialist. The biggest problems with being bedridden is developing pressure wounds or developing pneumonia. The best way to prevent pressure wounds is changing her body position every 2 hours and that will not be comfortable unless done with a specialty bed. She can exercise her lungs using an incentive spirometer frequently as well as taking deep breathes and coughing when she is awake.

If she can get in for a hip "nailing" and she has good bone growth, she will be back on her feet again. In either case, spending some time in a rehab facility will be most helpful for her.

My FIL fell at 96 and broke his hip. He went from the nh to the hospital and had surgery and repaired it and was back at the nh in 2 days walking on it. Did well.

There was no surgery to help my mom. At 93 it was determined she should go into hospice care. Prior to that, her PC doctor had given her opioid pain meds to deal with her pain. When the hospice doctor got involved, he took those meds away cold-turkey justifying by saying people with dementia do not feel any pain. I appealed and lost. My mother called me everyday for 18 months before her death crying in pain every time.

If your mother cannot be operated on to relieve the pain, I highly recommend advocating for her to have some type of pain relief - no matter what it takes!  It broke my heart to watch my mom suffer in pain....and for what? She was supposed to die within 6 months. Prior to hospice, she was never addicted. The pain medications just allowed her to function...to call her friends, sit up and watch TV, take a walk, etc. The only people who become 'addicted' are those who experience a 'high' on opioids and usually have some type of genetic pre-disposition, etc.

Agree with another answer. See another doctor and ask about the surgery. Not sure why she is not a candidate, but could remain in such pain for a lengthy period. It's not likely to heal on its' own so there has to be something that can be done for her.

Get another opinion when elective surgery continues...
since she’s in a lot of pain. If it’s broken then it won’t self heal. From my knowledge, hip surgery & rehab much easier than knee surgery & rehab. Was she walking before the hip fracture? She can get surgery & rehab to walk again. Hugs 🤗

My aunt was also not a candidate for surgery for her broken hip. She had heart and near end stage kidney disease and diabetes. The doctor told us she would be bedridden and in pain without the surgery or likely to not survive the surgery. We decided on the surgery. It was successful, but did add extra stress on her body and she ended up having to use oxygen all the time. She was also going to have to go on dialysis. About 6 months after the surgery, her hip had healed, but she refused dialysis and decided to go into hospice. She passed about a week later. She was 85. But she did it her way and without suffering in pain.

My mother fell and broke her hip, had surgery, and a replacement hip. She was on a walker a few months and was ready to walk on her own, when the new hip collapsed. She lived the next ten years using a wheelchair and living alone. A very brave woman. She had six children who visited often and helped. My brother lived four blocks away and stopped every morning and afternoon to a from his work place. We offered to take her in, but she wanted to remain in her own home. At 87, she developed heart problems, so 24 hour home care was necessary. Things sometimes work out.

My mother fell and fractured her hip at 96. The ortho Dr inserted 2 rods in her hip and leg. She went to rehab for 3 weeks. Uses a walker now.
My mom never had any pain whatsoever. Only when she couldn’t get up off of the floor we knew it was serious. But everyone is different. First time she ever had surgery. Only in the hospital two times to have her kids. Dr determined she could handle anesthesia so went forward with it.
Rather the surgery than lying in bed the rest of her life. She was always really active. Best of luck to you.

I am currently in the same situation with my 93 year old mom. She fell and has a displaced fracture of her hip. She was on hospice when this happened due to aortic stenosis for which she refused surgery. The hospital was going to put a pin in her hip until they consulted with her pulmonologist. He told them she could not be intubated; therefore she was not a candidate for surgery. It is likely her cardiologist would gave said the same thing about her heart.
She is now in an inpatient hospice as she requires more care than could be done in AL where my dad wanted so ge could be with her. She is in a great deal of pain, is refusing anything by mouth and is basically unresponsive. The hospice doctor gave her a week to 10 days max.
It is heartbreaking, but her living will said she did not want to be kept alive by any artificial means, so we are honoring her wishes. She also told us she did not want any treatment that would cause her pain.
I cannot imagine my mom being alive for months with this level of pain, so, Anonymous, if you can discus with your MIL, what does she want?

That’s when we put our MIL on Hospice, when she fell and broke her bone just below her pelvis. Dementia( stage 5-6) made us decide not to have it corrected. The recovery and healing would have been impossible. Healing happened while she was nursed along in bed with pain managed. After about three months or more pain meds were pulled and she remained bedridden in our home with hospice for three years with very little pain if handled correctly. We still had 6 kids living at home from ages 5-18 and we all cared for her till she In her finale stage 7, passed with pneumonia.

When my mother broke her femur just above the knee (simple in place fracture allowed the femur to break away from the knee replacement prosthetic) and was not a good candidate for surgery, the doctor provided a wrap and brace to help hold the broken portion together, proscribed a period of no weight on the leg, then reduced weight limited PT using a walker, followed by more weight and longer duration PT. Basically, as much PT as Mom could stand without developing significant pain. Doctor monitored the break with xrays every 2-6 weeks and directed we come in for an xray with any sudden change. She still has some pain with her knee when she over does it or moves a certain way and she doesn't have full flexion, but she can independently walk with a walker the 150 feet that ended Medicare supported PT. Function in the leg with the damaged knee is currently better than the undamaged leg with nerve impairment from spinal stenosis.

I would think your mother needs some kind of treatment that promotes healing the break. Without surgery it is unlikely to heal in a normal position, but even bones that heal out of alignment greatly reduce the pain from simple movement. With unaligned healing, she may never be able to walk unassisted again, but at least her pain should be greatly reduced. Because of her age, your mother may have been written off as likely to die from pneumonia before the bone could heal. Since she cannot be really "fixed" you may have to be fairly aggressive seeking a doctor to just treat her. Many surgeons are not in any way physicians and really don't like treat people who will have ongoing issues.

Thank you all for responding. She is on Home Health Care. Her bones are to frail for surgery. If she was more mobile before the broken hip her bones would have been stronger. That’s where the saying comes from, you don’t use them you lose them. She is going on 3 months now, was in rehab for a while. Learning to move without the use of her hip. The pain is just getting worse. Heartbreaking

What??? My father was 91 when he fell & broke his hip and had surgery to fix it. "Not being a candidate for surgery" is not an option in a situation like this, for obvious reasons. What makes her 'not a candidate', exactly? And how is her hip supposed to heal without repairs or a prosthetic one if a repair isn't doable? Makes no sense.

If general anesthesia is the issue with your MIL, I had my right hip replaced with a prosthetic one under ONLY an epidural! I chose Propofol to knock me out during the 90 minute procedure, or else I could have stayed awake like some people choose to do. An epidural creates none of the same 'waking up' issues as general anesthesia does for many people.

Please get her into see a bone surgeon right away and if that doctor concurs, then she'll need hospice for pain management, at the very least. Seems inhumane to me to do anything less.

Wishing you the best of luck and sending hugs and prayers your way.

I'd likely ask the doctor for his prognosis and recommendation for pain treatment OR get a second opinion. Long standing pain without treatment sounds horrible. What does the doctor say about it? Is she a candidate for hospice?

Your MIL needs to see an osteopath—a bone doctor. If there has been no healing in 3 months, something needs to been done for her. She must be in excruciating pain. Ask her primary care to refer her to one.