Silent slips trips and broken hips: the recovery experiences of young adults following an isolated fracture of the proximal femur

Abstract

Isolated hip fracture following a minor fall is a serious injury, normally requiring urgent surgical treatment and a complex recovery journey. Although commonly associated with the elderly, incidence and impact in adults under 60 years of age may be underestimated. The extensive literature almost exclusively focuses on the elderly, surgical interventions and relatively short-term outcomes. Young adults are also missing from the dominant societal discourse and healthcare policy on fragility hip fracture. They therefore represent a silent sub-subset of the fragility hip fracture population, whose recovery experiences and needs, particularly in the longer term, remain largely unknown. A critical interpretivist approach and The Silences Framework (Serrant-Green, 2011), were used to ‘give voice’ to young adults with isolated hip fracture. Thirty participants, between one and ten years post injury, completed an in-depth, minimally structured interview in which they told their story of recovery. An inductive, thematic analysis was undertaken integrating Braun and Clarke (2006) and the four phase cyclical analysis of The Silences Framework (Serrant-Green, 2011). One cross-cutting theme: Communication emerged, together with four other main themes: Experience of care, Impact on self, Impact on others and Moving forward. 11 The findings indicated wide variation in the quality of care, often influenced by social and professional norms regarding hip fracture patient characteristics such as age and mode of injury. Multi-faceted, often long term, physical, social and psychological impact on participants, their family and wider social networks was also found. This included Post Traumatic Stress Disorder type symptoms and impact on work, finances and relationships. The study highlighted some limitations of the current hip fracture care pathway for supporting the specific recovery needs of young adults. It also identified some limited effectiveness of commonly used patient reported outcome measures for hip fracture in this young client group. Exploring the recovery experiences of this under-represented group confirmed, but also altered the silences initially identified. Furthermore, it uncovered new silences which informed recommendations for future research; healthcare practice and policy. This study offers the first long term exploration of the impact of isolated hip fracture following a minor fall in young adults from their perspective. In doing so, it has also demonstrated the appropriateness of The Silences Framework (Serrant-Green, 2011) for guiding a person-centred, experience-based, acute orthopaedic/rehabilitation study undertaken by a student researcher.