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Forget About All the King’s Horses and all the King’s Men

AMH’s Geriatric Fracture team puts Ambler man’s hip back together again

William Lyman, 89, was tearing down the sound system after a church service at the retirement community where he lives. He worked alongside the chaplain as a volunteer, and frequently fought with a stubborn tripod that jammed on occasion. This time, however, when Bill yanked on the pole, he lost his balance and fell. “I was pretty sure I broke something,” says Bill. It wasn’t the tripod.

William Lyman

A few hours later, Bill was on an operating table at Abington Memorial Hospital, where Orthopaedic Trauma Surgeon Matthew Craig, M.D., surgically repaired Bill’s broken hip. Slightly over a month later, Bill completed intensive rehabilitation at his retirement community’s skilled nursing facility and returned to independent life in his apartment.

Bill was lucky. When you are an older adult, breaking a hip is risky business. In fact, many seniors need  long-term care and are at higher risk for developing such complications as a blood clot, pneumonia or infection after a hip fracture. Sadly, the mortality rate is high as well. Nationwide, about 20 percent of seniors die within the first year of breaking a hip, frequently as a result of complications.

Fortunately for Bill, when he tripped, he fell on the good fortune of being transported to Abington Memorial Hospital’s Emergency Trauma Center (ETC). Here, the multi-disciplinary team of ETC doctors, medical internists and orthopaedic surgeons follows a protocol to ensure that geriatric patients with fractures are evaluated and treated as quickly as possible. For patients who will benefit from surgery, the goal is to have them prepared for a procedure within 18 to 24 hours of the fracture. “This multi-disciplinary care combined with rapid optimization, expedited surgery, and early mobilization of geriatric fracture patients has many post-surgical benefits,” says Andrew Rosenzweig, MD, Division of Geriatrics, AMH. “Generally, patients experience a faster recovery, fewer complications and better long-term outcomes.”

 Before and After Leg X-Rays

Before and after Bill Lyman’s surgery

In the ETC, Bill was evaluated, received appropriate tests, and had his pain immediately managed. An X-ray showed he sustained an intertrochanteric fracture of his femur with subtrochanteric extension—a severe hip fracture. “It was a bad break,” recalls Dr. Craig, “but Bill was in good health and a good candidate for early surgery.”

“Within a few hours, I went from the ETC to the OR,” recalls Bill. “Dr. Craig emphasized it was important to fix the fracture as soon as possible, because it would help to prevent complications and increase my chances of returning to normal function.” During surgery, Dr. Craig inserted a long titanium rod inside Bill’s femur. He screwed the rod into the head and neck of the femur to compress the fracture. Next, he placed a small screw in the bone above the knee, and connected it to the rod. The rod stabilizes the fractured hip and allows the patient to bear full weight immediately after surgery.

It is especially important that older adults are up and moving as soon as possible after surgery to restore their function. Bill was on his feet the next day, supported by a walker. After only three days in the hospital, he was discharged to skilled nursing care in Spring House Estates—the senior living community he calls home. “My goal was to walk normally without assistance,” recalls Bill. He achieved that goal in just one month, thanks to a rigorous physical therapy schedule, determination, a strong work ethic and a lot of sweat. “I’m so grateful to Dr. Craig and the folks at Abington Memorial Hospital for getting me fixed up again.”

Prior to his fall, Bill had been active and independent. Every morning before breakfast, he would lace up his walking shoes and take to the trails for a one-mile walk on the grounds of Spring House. It’s been three years since his accident and these days, his walks are shorter. But at 92, Bill is still standing tall, looking regal with the walking stick he carries occasionally to assist with balance.