The objective of this chapter is to identify the gains associated with rehabilitation nursing care implemented in the elderly person with mobility deficit of the fractured femur. An integrative literature review with a qualitative synthesis retrospectively by 2014 was used. Older femur fractures undergo physical changes that affect their motor function and cause dependence in their activities of daily living (ADLs). From the specialized intervention in rehabilitation nursing, sensitive gains in mobility, functional independence in ADLs, hospital admission and rehabilitation time, quality of life and mortality rate, and health expenditures emerge were found. Fracture of the femur is usually associated with a fall from a height and occurs mainly in independent females in ADLs. In this population, gains that are sensitive to rehabilitative nursing care are recognized in the scientific evidence. The rehabilitation nurse thus has a relevant role in the qualification and quality of life of the person, with evident implications in the elderly care, in an institutional and community context.
TopIntroduction
A fracture is defined as the partial or complete interruption of the continuity and anatomical integrity of a bone or cartilage (Serra, Oliveira & Castro, 2012; Cunha, 2008). Its classification is made according to traumatic, stress or pathological etiology, with anatomical, proximal, medial or distal location, with soft, simple, exposed or complicated part injuries, and with a fracture tract, complete, incomplete, comminuted or by compression/crushing (Serra, et al., 2012).
Trauma is the most frequent cause of fracture of an extremity, which may be of low or high intensity, with direct or indirect application of the force of the impact on the fractured limb or traction of the muscle with insertion in the affected bone (Serra, et al., 2012). Stress fractures, also called fatigue or overload fractures, arise when the structures adjacent to the bone cannot absorb energy from a traumatic impact (Serra, et al., 2012; Cunha, 2008). Pathologic fractures are related to bone sites previously weakened by disease and can occur during normal activity or after a minimal accident (Cunha, 2008). General disorders of the skeleton (tumors, myelomas, osteoporosis, metabolic changes associated with phospho-calcium metabolism, hypercortisolism, hyperparathyroidism, Paget's disease, and osteosynthesis imperfections) and local bone diseases (bone tumors, bone cysts, osteomyelitis) (Serra, et al., 2012).
Regardless of its etiology, all fractures should be immobilized, since immobilization is essential for a quality bone consolidation process, for the prevention of lesions of adjacent tissues and for the prevention of complications associated with vicious consolidation (Cunha, 2008). Regarding fracture immobilization, physiological immobilization, which usually occurs immediately after the fracture occurs, consists of the resting of the fractured limb, external immobilization, which uses materials that include traction, castings, bandages, and immobilization, which consists of immobilization through the application of osteosynthesis material by surgical intervention (Cunha, 2008).
Femoral fractures can be classified according to location in fractures of the upper extremity of the femur, including fractures of the femoral neck or intra-capsular (sub-capital and trans-cervical) fractures and extracapsular (intertrochanteric and sub-trochanteric) femoral diaphysis fractures, supracondylar fracture, and intercondylar fracture of the femur (Serra et al., 2012). Nevertheless, of all the fractures that usually occur in the elderly, the fractures of the upper extremity of the femur, which have a maximum incidence in the elderly and present a morbidity that increases considerably from the 70 years of age, are highlighted. Of these fractures, the fracture of the femoral neck is characterized as a potentially deadly lesion whose mortality and morbidity increases with age and with the associated diseases, which is identified as the most common cause of traumatic death after 75 years old (Serra et al., 2012).
Definitive treatment of the fracture depends on the type and characteristics of the fracture. In the case of femoral fractures, surgical treatment is the most frequently used, and sometimes conservative treatment is not ruled out for a short time prior to surgery (Cunha, 2008).