Complications in Treating Hip Fractures in the Elderly

Understanding Medical Negligence in Hip Fractures

Hip fractures in the elderly are a significant public health concern, particularly in England and Wales, where the ageing population is increasing. A hip fracture can be life-altering for older adults, often leading to severe complications and a marked decline in quality of life. While surgery is the most common treatment, the recovery process is fraught with challenges that can result in long-term disability or, in the worst cases, death.

If you’re concerned about potential medical negligence in elderly care, click here to learn more about pursuing a claim.

The Challenges of Treating Hip Fractures in the Elderly

Hip fractures typically occur in elderly individuals due to a combination of factors like weakened bones (often from osteoporosis), reduced mobility, and an increased risk of falls. When an older adult sustains a hip fracture, timely surgical intervention is often necessary. However, even with surgery, several complications can arise, many of which are influenced by the patient’s age, pre-existing conditions, and overall health.

Key complications in treating hip fractures in the elderly include:

1. Delayed Mobility and Immobility: Post-operative recovery often involves a period of immobility, which can increase the risk of bedsores (pressure ulcers), blood clots, and pneumonia. Many elderly patients also find it difficult to regain full mobility, which affects their independence and increases the risk of further falls.
2. Infections: Infections at the surgical site or complications from conditions such as urinary tract infections or pneumonia are common in older patients due to their weakened immune systems.
3. Pre-existing Health Conditions: Many elderly patients have co-morbidities such as heart disease, diabetes, or respiratory conditions. These underlying issues complicate both the surgical procedure and post-operative recovery.
4. Cognitive Decline: Conditions like dementia or delirium can worsen after surgery, leading to confusion and difficulties in rehabilitation. Cognitive impairments can also affect the patient’s ability to follow post-operative care instructions, which can lead to complications.
5. Poor Bone Health: Osteoporosis, common in elderly patients, makes healing difficult, leading to slower recovery or even non-union of the fractured bone. In some cases, the bone may not heal properly, necessitating additional surgeries.
6. Medication Complications: Older adults often take multiple medications (polypharmacy), and this can lead to adverse drug reactions or difficulties in managing pain and infection post-surgery.

Mortality Rates Following Hip Fractures in England and Wales

Hip fractures are associated with high mortality rates among the elderly. The National Hip Fracture Database (NHFD)(2023) collects data on hip fractures and outcomes in England and Wales, and the statistics paint a concerning picture regarding the survival rates post-fracture.

• 30-day mortality rate: Around 6-10% of elderly patients die within 30 days of sustaining a hip fracture. This rate reflects the immediate risks associated with surgery and complications like infections, blood clots, or heart problems.
• One-year mortality rate: The one-year mortality rate for older adults following a hip fracture is approximately 20-30%. This elevated mortality rate is influenced by the high prevalence of underlying health conditions, reduced mobility, and complications during recovery.
• Hospital readmissions: A significant number of patients are readmitted to hospitals within months of surgery, often due to complications such as infections, poor rehabilitation outcomes, or the progression of underlying conditions.

These high mortality rates highlight the vulnerability of elderly patients with hip fractures, particularly those over the age of 85 or with multiple co-morbidities.

Reducing Risks and Preventing Medical Negligence in Hip Fracture Treatment

To reduce the risks associated with treating hip fractures in the elderly, it’s crucial that healthcare teams implement comprehensive care strategies:

1. Early Surgery: Guidelines recommend that elderly patients receive surgery within 36 hours of a hip fracture. Delayed surgery increases the risk of complications such as infections, pneumonia, and blood clots.
2. Multidisciplinary Care: The involvement of a multidisciplinary team, including surgeons, geriatricians, physiotherapists, and occupational therapists, can improve outcomes by addressing the patient’s full spectrum of health needs.
3. Post-operative Rehabilitation: Effective rehabilitation, including physical therapy, is essential to help elderly patients regain mobility and independence. Programs that focus on early mobilization reduce the risk of long-term immobility and its associated complications.
4. Bone Health Management: Osteoporosis screening and treatment are critical to improving bone health post-fracture and preventing further falls or fractures. Medications such as bisphosphonates or calcium supplements may be prescribed to strengthen bones.
5. Prevention of Falls: Preventing future falls is crucial in elderly patients. This can involve home modifications, balance and strength exercises, and the use of assistive devices like walking frames.

Pursuing a Medical Negligence Claim for Hip Fracture

Hip fractures in the elderly are not just an orthopaedic emergency but a medical crisis that can lead to significant morbidity and mortality. In England and Wales, the mortality rates following hip fractures are sobering, with many elderly patients succumbing to complications within a year of their injury. The challenge lies in not only treating the fracture but also addressing the underlying health issues that exacerbate recovery difficulties.

By providing comprehensive, multidisciplinary care and focusing on fall prevention, the risks associated with hip fractures can be mitigated. Families and caregivers play a critical role in ensuring that elderly loved ones receive the best possible care, including early intervention and support during rehabilitation.

If you or a loved one has been affected by the topics discussed in this blog post, then don’t hesitate to reach out to our team of Medical Negligence Solicitors who are experts in this area.

Claim for Damages Following a Fall in a Care Home

A Fictional Case Study*

*This case study is used for illustrative purposes only

Background

An 85-year-old resident care home female resident suffered from advanced dementia and had been living at the facility for over two years. Due to her declining physical and cognitive condition, she was considered a high risk for falls. As part of the care plan specified for her, it was noted that she needed close supervision and appropriate fall prevention measures, such as bedrails, crash mats, and alarm sensors to alert staff if she attempted to leave her bed unaided.

However, one night in March 2023, the resident fell from her bed during the night, resulting in a severe hip fracture. At the time of the incident, there were no crash mats in place, nor were there any bed alarms or sensors to notify staff of her movements. The fall went unnoticed until a care worker discovered the resident the following morning. The injured resident was taken to the hospital for surgery, but complications arose due to her age and frailty, significantly impacting her quality of life.

The resident’s daughter believed the fall would have been entirely preventable had the care home followed proper safety protocols. After seeking legal advice the daughter decided to assist her mother to pursue a claim for damages against the care home for negligence, citing the failure to provide adequate fall prevention measures and a lack of supervision.

Key Details of the Care Home Fall Claim

1. Breach of Duty of Care

The claim was based on the fact that the Care Home had a duty of care to ensure the Resident’s safety and well-being, particularly given her high risk of falls due to her dementia. The care plan clearly identified the need for preventative measures, yet the care home failed to implement them. This breach of duty was the cornerstone of her claim.

Specifically, the allegations included:

• Failure to Provide Supervision: The Resident had been left unsupervised for long periods, even though her condition required regular checks and monitoring during the night.
• Lack of Preventative Equipment: The care home did not use crash mats or motion sensors, which were essential safety measures given her risk of falling. These tools would have likely prevented the injury or alerted staff to her movements, allowing them to intervene prior to falling.
• Inadequate Risk Management: Despite being aware of the resident’s vulnerability, the care home failed to adjust her care plan to reflect her increased need for supervision and protection.

2. Medical and Emotional Impact

The hip fracture sustained as a result of the fall required surgery, which led to a prolonged hospital stay and complications including a chest infection and decreased mobility. Before the fall, the resident had limited mobility but could walk short distances with assistance. After the surgery, her physical condition deteriorated significantly, and she became bedridden, and her cognitive abilities declined rapidly, and she became increasingly confused and agitated, further reducing her quality of life.

The resident’s daughter had the emotional toll of watching her mother suffer was immense. She was deeply affected by the knowledge that the incident could have been prevented, and her mother’s final months of life were spent in pain and confusion due to the fall.

3. Basis for Compensation

Compensation was sought for both special damages and general damages:

• Special Damages included the cost of medical treatment, hospital stays, and any additional care required after the fall, as well as the cost of modifying the resident’s care environment post-injury.
• General Damages were sought for pain, suffering, and the loss of amenity caused by the injury. The resident’s ability to engage in even basic activities had been taken away, and the decline in her mental and physical state after the fall was dramatic.

Legal Outcome: Compensation for Care Home Falls

In a case such as this the likelihood is that it would be settled in the Resident’s favour, subject to proving negligence and causation and loss. The care home should admit liability for the fall and acknowledge that they had failed to provide the appropriate level of care and had not implemented necessary fall prevention measures.

Compensation included damages for the pain and suffering endured by the resident and the financial costs associated with her care and medical treatment following the fall. The care home also agreed to review and improve its fall prevention protocols, including the installation of crash mats, bed alarms, and increased supervision for high-risk residents.

Conclusion

As an example, this hypothetical case underscores the importance of care homes adhering to their duty of care, especially for vulnerable residents like those with dementia who are at high risk of falls. In this theoretical instance, simple and affordable measures like a crash mat and warning sensors could have prevented her injury.

A settlement provides some closure for a family and Claimant, but it also highlights the need for care facilities to take more proactive steps to ensure resident safety. Families placing loved ones in care homes must be vigilant in ensuring that adequate risk assessments and fall prevention strategies are in place to avoid the many variations of tragic incidents explored here.

If you or a loved one has been affected by the topics discussed in this hypothetical case study, then please get in touch with our team of Medical Negligence Solicitors who specialise in Nursing and Care Home Claims.

Claiming Compensation for a Perineal Tear Caused During Childbirth

A complication of Childbirth can be a perineal tear, a painful injury that occurs during delivery. While some degree of tearing is common, more severe perineal tears can have long-lasting consequences. Mothers who have suffered significant injuries such as Grade 3 and Grade 4 may be entitled to perineal tear compensation if the tear resulted from medical negligence.

What Are Perineal Tears?

Perineal tears occur when the skin and muscles between the vaginal opening and the anus (the perineum) tear during childbirth. Perineal tears are classified into four categories:

• Grade 1: A small tear affecting only the skin around the vagina and perineum.
• Grade 2: A tear that extends deeper into the muscles of the perineum.
• Grade 3: A more severe tear that extends through the muscles around the anus (anal sphincter).
• Grade 4: The most severe tear, extending through the anal sphincter and into the lining of the rectum.

Grade 3 and Grade 4 tears, also known as obstetric anal sphincter injuries (OASIS), are serious and can lead to long-term problems, including incontinence, pain during intercourse, and emotional trauma.

How Common Are Grade 3 and 4 Perineal Tears?

According to the latest statistics, approximately 3% of vaginal deliveries in England and Wales result in a Grade 3 or 4 perineal tear. The exact number of these tears can vary year on year, but it is estimated that around 15,000 to 17,000 women suffer from these severe tears annually across the UK.

Increased awareness of these tears has led to improved recognition and recording by healthcare providers, but the numbers still indicate a significant risk for mothers giving birth.

Can Perineal Tears Be Prevented?

Whilst not all perineal tears can be avoided, there are several ways in which the risk of severe tearing can be reduced during childbirth:

1. Antenatal Perineal Massage: Massaging the perineum in the weeks leading up to childbirth may help to soften the tissues, making them more elastic and less likely to tear.
2. Optimal Birthing Positions: Certain birthing positions, such as squatting or being on all fours, can reduce the likelihood of severe tears.
3. Controlled Delivery: Healthcare professionals can help to guide the baby’s head gently during delivery to reduce strain on the perineum.
4. Episiotomy: In some cases, a small incision in the perineum (an episiotomy) may be performed to prevent a more severe tear from occurring. However, this should only be done when necessary and under informed consent.
5. Training and Awareness for Healthcare Providers: Proper training and careful attention by midwives and obstetricians are essential to managing labour and minimizing the risk of severe tearing.
6. Caesarean Section Delivery

Despite these preventive measures, some women may still experience Grade 3 or 4 tears, and in some cases, these tears may be the result of medical negligence.

When Is a Perineal Tear the Result of Medical Negligence?

A perineal tear may be considered the result of medical negligence if healthcare providers failed to act according to accepted standards of care. Some common examples of negligence include:

• Failure to perform an episiotomy when it was clearly needed.
• Poor management during delivery, leading to excessive tearing.
• Failure to diagnose or repair a tear properly after childbirth.
• Lack of consent before performing interventions like an episiotomy or instrumental delivery (forceps or vacuum).

If negligence can be demonstrated, you may be entitled to claim compensation for your injuries.

How to Claim Compensation for a Perineal Tear

If you believe you have suffered a Grade 3 or Grade 4 perineal tear due toa mismanaged delivery , our specialist solicitors can advise you whether you may be entitled to recover compensation for your injuries and advise you on the further steps that can be taken.

Where we are able to help your claim would be handled on a “No win No fee Basis”

Reasons for making a Perineal Tear claim?

Compensation for perineal tears can cover a range of damages, including:

• Physical pain and suffering caused by the tear and any subsequent surgeries or treatments.
• Loss of earnings if your injury prevents you from returning to work.
• Medical expenses, such as physiotherapy or incontinence treatments.
• Emotional distress and psychological trauma, which are often associated with childbirth injuries.
• Future care costs for ongoing medical treatment or care.

Speak to our Medical Negligence Solicitors today

Severe perineal tears can have a lasting impact on a mother’s quality of life. While not all tears can be prevented, healthcare providers have a duty to minimise the risks and provide appropriate care. If you believe your injury was the result of medical negligence, it’s important to seek legal advice as soon as possible.

Making a compensation claim can help you secure the financial support you need to recover and rebuild your life after such a traumatic experience. If you or someone you know has suffered a perineal tear during childbirth, do not hesitate to reach out to our team of Medical Negligence experts.