Hip fracture and no surgery. How to deal with pain from it all?

I'm going to talk in a little more detail about my mother, the main point being that not all hip fractures are created equal and what works for one old lady may not be appropriate for another. In my mother's case the hip broke and caused her to fall, not the other way around. Here is the email I sent to my sisters after visit to the ortho doc two weeks post fall:
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Mother's x-ray revealed that the hip fracture did not heal together. Instead, she has avascular necrosis of the bone stem that normally connects to the ball that goes into the hip socket. That means the stem does not exist any more. There is a gap between the leg bone and the hip socket.

The usual treatment for this would be a hip replacement. Because of her age, her weak bones, and her dementia, Ma is not a good candidate for this kind of surgery.

When weight is placed on that leg, the femur is pushed up but the bone it would normally push against is missing. This is painful.

Therapy on the hip is not advised. Therapy to enable her to transfer is probably not feasible because of the pain level it would involve.

He did recommend (and write an order for) upper body therapy, so she retains her ability to feed herself, turn magazine pages, etc.
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Putting weight on that leg would be painful, forever. This was minimized with a regular schedule of pain meds and not putting weight on that leg. She sometimes hollered during transfers, if that foot touched the floor, but it was over quickly. She went to all activities and entertainments, in her wheelchair.

My hip broke last year and I was given the choice of a replacement or having the fracture pinned. I chose the replacement because the surgeon said pain often increases to the point where the only choice is a replacement. I did not want to have to go back for more surgery when I am 85.
50 years ago there were no replacements and the patient was confined to bed in hospital on traction for 12 weeks. I do not recall there being a huge amount of pain associated.
Now in order for Mom to go and see specialists there is no reason she can not be prescribed a heavier dose of narcotic so she can tolerate the process.
It is of course Mom's choice if she is of sound mind to refuse any or all treatment whether it would improve her quality of life or not.
Sufferers from MS do tend to become depressed which is not surprising.
There is help out there so do your best to get her to agree to at least better pain control.
Physical therapy could be ordered before any planned surgery to increase her strength and make the chance of a successful rehab possible.
The key maybe whether she would be able to tolerate the anesthetic and only the anesthesiologist can determine that and possibly a cardiologist and pulmonologist depending on how disabled with the MS she is. It can be done under spinal anesthesia and sedation if she is prepared to endure that.

Poor lady.

I suppose if she hasn't been weight bearing for many, many years then the general condition of her muscles and bone will have suffered. And she must be thoroughly fed up with being poked and prodded by doctors over all that time.

It certainly would be a good idea to get *all* of the information you can together and get one person to review it and do a detailed assessment before you develop a care plan to move forward with. That one person could be a pain specialist, or a geriatrician, or whoever is taking the lead on her MS; but the key thing is to look them in the eye and make sure they are considering *everything* together.

MS or no MS, I refuse to believe they can't improve on the quality of life she is enduring now. It can be hard to get specialists to talk to one another, but give it your best shot - and please keep in touch with us.

I will talk to my mom and her hospice nurse about going to see a pain specialist. (She was immediately put hospice that after her seizures, the ER dr as well as the nurse didn't think she'd survive long with her breathing patterns and mottling of her legs, she is now doing much much better but they are keeping her on hospice for a little longer) I find it very sad that she's stuck in the nursing home. We live near her so it would be nice for to be able to visit again.

One reason we were told that an operation would not be good for her, is because the most movement she does with her legs is assisted standing to transfer, and she would not form enough muscles to help her "new" hip heal and the chance of future dislocation of the joint would be very high. The surgical dr also told us that her hip would never truly heal, that's why I say it's broken. That could be very wrong. But she did go to the ER for a fall a few months ago (before her seizures). Her hip was x-rayed and the dr made it sound like nothing was there at the ball of her femur. He said there was no blood flow so the bone eventually dies. I wish I questioned him more on that then but at the moment I was concerned on my moms current pain (from being transferred so many times in a short period). I also am now wondering if I should pursue this x-ray more and perhaps I can get it sent to a pain clinic.

She has no other known conditions besides her MS. She's had it for about 36 years, if not longer.

H'm.

I'm not medically qualified, but even so. At 67, even allowing for the MS, if this is a three year old fracture it should have healed by now. My mother's fractured neck of femur (is that the part of the hip your mother broke, too?) also wasn't operated on, she was 60-ish, and she was up and about on crutches not more than two months later.

So although the bone may have healed badly, not in the right position, it surely can't still be broken as such.

Also: hip replacements can be done under other types of anaesthesia such as epidural blocks - my uncle's choice when he was considerably older.

The MS must complicate everything. Does your mother have other known conditions too? And how long has she been living with MS?

I heartily second the suggestion to see a pain specialist who can review all that is going on and help get things under control. It sounds as though your mother's fear of investigations might be something to discuss, too. After all, when you think about it, pretty much anyone who has to have an x-ray is going to be ill and/or in pain - radiographers are pretty good at keeping their patients as comfortable as possible, not least because it's important that they lie still.

Above all bear in mind that your mother is *young*. 70 is no age to be under permanent house arrest in a Nursing Home. I really hope you'll be able to get something done for her.

Thank you for responding! She has not seen a pain specialist. We were told from a neurologist that she would need many tests done that she refuses to do, in order to receive treatment... her pain is too bad for her to even travel from her nursing home so getting any scans would be just torture for her.

Her fentanyl has been gradually increased from 12.5 over the past year. It’s getting to the point where she may need it increased again. She would rather not since it just makes her groggy, forgetful and drugged up feeling. She is the type of person who refuses to lay in bed and she gets anxious just being in her room for the day. I don’t think there is much out there for someone in her situation. But it never hurts to ask, especially here where everyone has always been so understanding. :)

Do you know how they managed your mom’s pain? Was it the same thing basically?

Your mother prefers the level of pain she has to increasing her fentanyl? Hmm ... do you know why?

To me the most important thing would be getting her pain under control, and I'd sacrifice a lot to that.

My mother's hip break was inoperable, too, and in fact she was released from the hospital to the NH on hospice. But she improved, they managed the pain, she got off hospice, and lived another 2+ years, pretty contentedly. So, don't give up hope! Has she seen a pain specialist? It seems to me that managing the pain is the first priority.