What Are Hip Fractures?

A hip fracture refers to a break in the upper portion of the femur (thighbone). Most hip fractures occur in senior patients with osteoporosis. For younger patients, hip fractures occur when a strong external force is applied to the hip (e.g. a bad fall or vehicle collision). As they are very painful, immediate surgical treatment is highly recommended.

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Hip Fractures

 

Where Do Hip Fractures Occur?

As a ball-and-socket joint, the hip consists of the upper part of the femur (thigh bone) and the pelvis. The ball is the femoral head that fits into the socket, also known as the acetabulum, of the pelvic bone.

 

Hip fractures occur around the upper femur. In general, four main areas can be injured. They are:

 

  • Femoral neck – The area of the femur below the ball (femoral head).
  • Intertrochanteric area – The area below the neck of the femur and above the long part or shaft of the femur. It is called intertrochanteric because it is marked by two bony landmarks: the greater trochanter and the lesser trochanter.
  • Subtrochanteric area – The upper part of the shaft of the femur below the greater and lesser trochanters.
  • Femoral head – The ball of the femur that sits in the socket.

 

Intertrochanteric and femoral neck fractures are the most common types of hip fracture while femoral head fractures are extremely rare.

 

What Are The Causes & Symptoms of Hip Fractures?

For elderly patients with osteoporosis, hip fractures are typically caused by low-energy falls. This is because their bones have become weakened by osteoporosis and even a small external force may be enough to cause a fracture.

 

Stress fractures may occur in the femoral neck. Stress fractures are caused by repeated impact to the bone and are often seen in long-distance runners. When stress fractures occur in the subtrochanteric region of the hip, they are usually associated with prolonged use of certain osteoporosis medications.

 

Femoral head fractures are usually caused by a high-impact event such as a vehicle collision or a fall from a great height.

 

Like most fractures, hip fractures are very painful and are localised to the upper thigh and groin. Other symptoms include:

 

  • Inability to put weight on the affected area
  • Inability to move the upper part of your leg

 

How Are Hip Fractures Treated?

In most cases, hip fractures require immediate surgical treatment. The doctor will do a physical examination to gauge the mobility of the hip and run diagnostic tests like X-rays, MRI, and CT scans to determine the location and extent of the damage. They will also take your medical history, age, and overall health into consideration as well. In general, you can expect to undergo surgery within 48 hours of getting a hip fracture.

 

Surgical treatment is given according to the area of the injury.

 

Femoral Neck Fracture

If a femoral neck fracture is not displaced, the most common treatment is insertion of screws. In this procedure, surgical screws are passed across the fracture site to hold the ball of the femur in place while the fracture heals.

 

Displaced femoral neck fractures are more difficult to treat. This is because the posterior capsule, the structure through which blood supply comes to the femoral head, will be damaged as well – thus causing a lower chance of healing for the fracture. Even if it does heal, avascular necrosis may develop in the head of the femur. This causes damage to the bone cells, the collapse of part of the femoral head, and subsequent arthritis. As a result, displaced femoral neck fractures are treated with hip replacement surgery (interlink to hip replacement surgery page).

 

Intertrochanteric Fracture

Intertrochanteric fractures occur below the femoral neck in the wider region between greater and lesser trochanters. The bump that you feel on the side of the hip is the greater trochanter. Fractures in this area may result in multiple fragments.

 

Intertrochanteric fractures are surgically treated with either:

 

  • A sliding compression hip screw and side plate that is fixed to the outer side of the bone with bone screws. A large secondary screw (lag screw) is placed through the plate into the femoral head and neck – allowing for compression at the fracture site to increase stability and promote healing
  • An intramedullary nail that is placed directly into the marrow canal of the bone through an opening made at the top of the greater trochanter. One or multiple screws are then placed through the nail and into the femoral head.

 

Greater Trochanter Fracture

Often a result of a low-energy fall, a greater trochanter fracture can usually be treated without surgery. While painful, these fractures are stable and can heal with protected weight-bearing such as using crutches or a walker.

 

Subtrochanteric Fracture

Subtrochanteric fractures involve the upper part of the femur, just below the hip joint. Surgical treatment for this fracture involves inserting an intramedullary nail into the shaft of the femur and a screw placed through the nail into the femoral head. In order to prevent bones from rotating around the nail or from shortening (telescoping) the nail, additional screws may be placed at the lower end of the nail near the knee. They’re called interlocking screws.

 

Femoral Head Fracture

If the femoral head fracture is not displaced, it may be treated nonsurgically with limited weight-bearing. If there is a small displaced fragment that does not involve a large part of the joint surface, then the fragment will be removed.

 

If there is a large fragment in a young active person, open reduction and fixation with screws are often done. In an older person, hip replacement—either partial or total—to replace the damaged femoral head is recommended.

 

If there is a large fragment in a young active person, open reduction and fixation with screws are often done. In an older person, hip replacement—either partial or total—to replace the damaged femoral head is recommended.

 

 

What Is The Expected Recovery For Hip Fractures?

The recovery period will vary from person to person and also depends on the severity of the injury. Nevertheless, for most patients, starting physical therapy the day after surgery is highly recommended. They will also be given antibiotics and medications after surgery to reduce pain and chances of infection. A physiotherapist will also help them get used to using supporting devices such as a walker or crutches.

 

Many patients go home after hip fracture surgery, but some will need short-term care in a rehabilitation facility.

recovering from hip fractures

Usually, these patients are elderly or have no caregivers at home. If you go to a rehabilitation facility, you will need to stay there until you can walk independently and manage your daily activities. This is because, after hip surgery, your movements may be limited for a while. Reaching for high objects, bending down, and twisting are just a few of the things that you may have difficulty doing in the first few weeks following surgery. For those who can go home after surgery, they are highly recommended to attend regular physiotherapy sessions. Fortunately, with consistent physical therapy, your muscles will strengthen and mobility will be restored.

 

If you have had a procedure that includes internal fixation, it may be several weeks before you can bear full weight. If you have had a hip replacement, you can most likely be allowed to full weight bear right away.

 

What Are The Potential Complications of Surgery For Hip Fractures?

All surgeries carry some amount of risk and complications but they are usually quite low. Common complications of hip surgeries include infection around the surgery wound and blood clots forming in the veins of the legs or pelvis

 

Your surgeon will discuss the risks with you in detail and will go over the necessary precautions that they will take to minimise the chances of complications occurring.

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