Once there was a woman who was stuck inside her bathtub for three days before help arrived to get her out. She couldn’t get herself out of the tub! She lived alone in the third-floor apartment of a Boston triple-decker.
Fortunately, it was summertime when this happened so she was able to stay hydrated. There were towels nearby for warmth and cover. When I met her to do a home therapy visit she wanted every possible safety feature installed in the bathroom. She had lived through a traumatic experience that she didn’t want to repeat. Her life goal was to Age in Place. She understood that doing so would require use of bathroom safety equipment. She didn’t care how that looked. She only cared about being safe at home.
Falls lead to fractures
Falls lead to fractures and fractures lead to pain and disability. Disability and pain have many hidden costs. Often a fall with fracture leads to a hospital and rehabilitation stay. Many people do not come home from rehab but remain in a facility for long-term care. A fall with fracture can be a sentinel event, meaning a tipping point in someone’s life that starts them on a different lifestyle, in assisted living or nursing home care.
Fracture care at the hospital
Many fractures are surgically repaired and others are not. Hip, wrist, and leg fractures often are repaired. Knee cap, neck, and humerus fractures often are not repaired. Those patients may be discharged from the hospital with braces and slings as well as doctor’s orders for restricted activity and weight-bearing restrictions. Just like that, in the blink of an eye, life changed and not for the good! It is a difficult adjustment for patients and caregivers alike. Stress, anger, blame and guilt are prominent themes.
How does one care for a fracture at home?
Many caregiving requirements are intuitive. The injured person may need help with personal care activities. Someone with a fracture cannot usually manage at home alone. Besides the obvious injury, there are often aches and pains, or other injuries that gradually develop. Sometimes there’s another fracture that was not identified in the initial workup. Anxiety about preventing another fall is always present.
Usually, there is bruising and other soft tissue wounds that make movement painful. Fear about the future is a common theme.
Pain medication
Pain medication is an expected part of post-fracture care. Pain meds have side effects and dosing is not exact. Some people experience mental status changes when taking pain meds. In general, low dosing of pain meds is how doctors begin the medication routine. If the pain meds aren’t effective or well tolerated, call the doctor to report that. Pain is also managed by positioning. Elevation is an important aspect of that to reduce swelling. Pillows are the typical go-to solution for the elevation of an injured limb.
Ice or cold treatment for pain and swelling
Ice and cold are important aspects of pain management. People will put ice cubes in plastic bags and hope they don’t leak. There are gel ice packs available from the drugstore that can be reused after a spell in the freezer. You can make ice packs at home with plastic bags, water, and rubbing alcohol. Google has the recipe.
The great thing about ice treatment is that it numbs the pain and contributes to reduced swelling. Cold treatment is non addictive and doesn’t affect mental status. The tricky part of it is to keep the ice securely in the right place for pain relief.
Ace bandages are perfect for wrapping an ice pack securely on an arm or a leg. A folded bed sheet can also be used to loosely secure an ice treatment against an injured body part.
Ice therapy machine
For more intensive, long term cold treatment there are commercially available ice therapy machines that hold a reservoir of ice+water. You can see on on the Shop/Products section of this website. The icy water is stored in a reservoir of the machine. It then gets pumped through tubing to a flat pad that can be laid on top of, or surrounding a painful area. In the case of back pain, the flat pad can be laid upon or against, relatively comfortably. Be sure and follow the instructions on the ice therapy machine for precautions.
Ice/cold is the treatment of choice for the management of fractures with pain and swelling. An example of an ice therapy machine is shown in the picture below.
Elevation
A key element of home care for someone with a fracture is elevation. An arm injury is often elevated with use of a sling, if the sling is properly applied. A leg injury is elevated with use of pillows. Someone with a leg fracture may be unable to walk so a wheelchair is used with elevating leg rests. A neck fracture requires resting in a semi reclined position to accommodate the angle that the neck brace requires. Often someone with a fracture finds lying flat in bed uncomfortable and chooses to sleep in a recliner chair instead. It may be that comfort, especially during sleep is difficult to achieve in spite of your best efforts.
When Assistance is Required....
When someone returns home after a fall with fracture, the patient and family are understandably stressed and fearful that the same situation could happen again. Some families require their injured member ask for help with anything and everything that involves mobility. The family group needs to work together to find the right balance of independence and assistance for the injured. Every member of the household should get involved in some way, to avoid caregiver burnout.
Some people will be new to using a wheelchair, walker, brace, splint, sling or other medical equipment that is unfamiliar to them. Furniture in the home might need to be rearranged. Rugs may need to be taped down or rolled up and put away. Sleeping in a different part of the home might make sense. Routines need to be established to adapt to the new situation. Nursing and therapy helpers may begin entering the home and disrupting usual family routines. It’s a time of adjustment for families who provide care at home.
