We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Below we will list the departments and units that form part of Vall d’Hebron Hospital and the main diseases that we treat. We will also make recommendations based on advice backed up by scientific evidence that has been shown to be effective in guaranteeing well-being and quality of life.
We will guide you from your first visit to the centre, allowing you to find all the departments and make the most of our facilities. Whatever the reason for your visit, we will explain how to get about the hospital.
Hip fractures involve a change in the autonomy of elderly patients, negatively affecting their quality of life and altering their family and social environment, as it causes a change in their prior functional capacities, with a high risk of complications.
The femur is the longest bone in the human body. It should be stated that a femoral fracture in elderly people basically affects the end nearest the hip joint. For this reason, the best-known name for this type of fracture is hip fracture. We should not understand this health problem as a fracture of a long bone that affects an elderly person, but rather as a gateway leading to their physiological and functional situation, and their underlying conditions, becoming decompensated.
The classic symptoms are pain in the hip area, reported by the patient themselves, when they can, along with the associated functional impotence. Furthermore, the affected limb tends to be shorter and presents external rotation (with the lateral side of the foot touching the bed). In patients with cognitive deterioration, who cannot communicate the level of pain they are suffering, a decrease in their functional situation can be a symptom that should make us suspect a “hidden” fracture.
The population incidence of hip fractures in Catalonia for patients aged > 65 is around 600 cases / 100,000 inhabitants per year. The perspective is that this figure will increase in coming years, due to the increase in life expectancy and an increasing population.
At Hospital Vall d'Hebron in 2020, the year of the Covid-19 pandemic, we operated on a total of 693 hip fractures. In 2019, surgery was performed on 720 fractures. In other words, these are fractures that occur under normal circumstances of patients falling over.
The average age where this occurs is 85 years old, and it affects women in 75% of the cases. Some of the risk factors for women may be early menopause and hormonal treatment. A prior fracture (radius or spine are the most frequent), obesity, smoking and a sedentary lifestyle are risk factors in general.
The suspected diagnosis can be made from typical clinical signs and symptoms, as stated above.
In regard to treatment, it has been demonstrated that surgery on hip fractures in the elderly population increases survival, when compared to a non-surgical treatment, as it permits the patient's early movement without pain, thereby avoiding added complications. For this reason, at present, the treatment of choice is surgical treatment. However, there are some exceptions.
A multi-disciplinary approach is important, with the collaboration of specialists in geriatrics, internal medicine and anaesthesiology for the preoperative optimisation of the patient and early surgery, as a rule within the first 48 hours.
It is essential to classify the fractures according to their location, in order to decide on the type of surgical treatment. Intracapsular fractures seriously affect the vascularisation of the femoral head, and for this reason, the most popular option for treatment is to replace it with an artificial head, in the form of a hip prosthesis, especially in displaced fractures. Depending on the patient's age and functional situation, we may opt for a partial or total prosthesis, reserving the second option for younger patients with a better quality of life. Some non-displaced intracapsular fractures can be treated percutaneously, using screws. Extracapsular fractures, of which pertrochanteric fractures are the most common, do not compromise the vascularisation of the femoral head, and for this reason it is not necessary to replace it with a prosthesis. Percutaneous treatment with intramedullary nailing is usually the treatment of choice.
The postoperative period is also very important. Close collaboration with rehabilitation and physiotherapy services is established so that patients do not lose their prior functional capacity. Furthermore, social workers assess the social situation of each patient, in order to ensure an appropriate hospital discharge.
Diagnosis confirmation is usually carried out with a simple x-ray of the pelvis. In cases where the x-ray does not show a fracture, as may occur in the case of some non-displaced intracapsular fractures, tomography (CAT) is usually the technique of choice.
Hip fracture prevention is based on the adoption of healthy habits, such as a balanced diet that is rich in calcium and vitamin D, doing physical activity every day, within the person's functional capacities, and avoiding tobacco and alcohol.
It is also important to prevent falls, by means of appropriate closed footwear with a non-slip sole, standing up slowly, without haste, programming visits to the toilet to avoid rushing, wearing glasses and hearing aids, not walking in the dark or on went floors, etc.
Anaesthesia, Resuscitation and Pain Management
Physical Medicine and Rehabilitation
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