A break to any part of the upper quarter of the femur, or thighbone, is called a hip fracture. Hip fractures are serious injuries, often requiring surgery and extensive recovery time. Please read on to learn more about hip anatomy, and the causes, diagnosis, treatment, and rehabilitation of hip fractures.
Anatomy of the hip area
The hip is a ball and socket joint that allows the upper leg to move about the pelvis. While considered a hip injury, damage to the socket portion of the joint (also called the acetabulum) is not considered a hip fracture and requires treatment different from what is described here. Keep reading to learn about the causes of hip fracture.
Causes of Hip Fracture
|Causes of Hip Fracture
||Risk factors for Hip fracture
Symptoms of Hip Fracture
In patients who suffer hip fracture due to traumatic accident, pain in the upper thigh and/or groin will often be the primary symptom, which is moderate to severe even in the absence of movement. In some cases, the injured leg may appear shorter than the other leg.
In cases where illness or previous injury has weakened the bone, aching in the thigh or groin may precede a break.
Diagnosing Hip Fracture
As with most fractures, an orthopedic doctor will use diagnostic imaging techniques—such as X-ray, CT scan and MRI—to determine the location, type and severity of hip fracture.
Once the fracture has been observed through diagnostic imaging, the physician will determine what type of fracture was sustained. There are three different types of hip fracture, based on the location of the upper femoral fracture.
Types of hip fracture
- Intracapsular Fracture. These hip fractures are located at the neck and head of the femur, usually within the joint capsule. This capsule is composed of soft tissues and the fluid that lubricates and nourishes the hip joint.
- Intertrochanteric Fracture. This type of hip fracture occurs between the femoral neck and the lower bony portion of the femur called the lesser trochanter. This bony point is one of two points that attach major muscles to the hip (the other being the greater trochanter).
- Subtrochanteric Fracture. The type of hip fracture affects a portion of the femur below the lesser trochanter.
- Multiple fractures. In more complex and serious cases, fractures can occur to more than one of the above locations. In these cases, surgical repair is usually required.
Before determining the proper course of hip fracture treatment, a doctor or medical team will evaluate the patient’s overall health and medical condition. In some cases, a hip fracture may be stable enough that non-surgical methods may successfully assist in healing. In other cases, patients who may otherwise benefit from surgery, may not be good candidates for surgery because of existing weakness and illness. A patient’s overall health, comfort levels, and degree of pain will have to be carefully weighed with the risks of surgery to determine the best course of treatment.
Most orthopedic surgeons believe that patients are more successful with treatment when surgery is performed fairly soon after injury. Again, the treatment plan will be determine by the patient’s specific circumstances. In some cases, cardiac and other studies will be performed prior to surgery to make sure a patient is safe for the procedure.
Non-surgical hip fracture treatment
Some fractures, in which the bone has not been significantly displaced and is stable, may not require surgery. Non-surgical treatment will also be pursued for patients who are too ill to receive anesthesia and those who were unable to walk prior to the hip fracture.
This course of treatment involves immobilization and periodic re-examination of the fracture through x-rays. If patients are confined to a bed or wheelchair during immobilization, they may also need to be examined for complications such as bed sores, infections, pneumonia, blood clots, and nutritional wasting.
Surgical Treatment of Hip Fractures
Preparing for Surgery
The anesthesia used for hip fracture surgery will come in the form of either general anesthesia through a breathing tube or spinal anesthesia. In rare cases, only a local anesthesia with heavy sedation may be used. During and after surgery, antibiotics will also be administered to reduce the risk of infection.
Before surgery, a doctor may recommend certain tests, such as blood tests, electrocardiograms, x-rays, and urine samples. Particularly with older patients, a doctor may look for an undiagnosed urinary tract infection, as these infections can lead to post-surgical hip infection.
Surgery for Intracapsular Fracture
If the head of the femur (“ball”) alone is fractured, surgery will be geared towards repairing the cartilage that has been injured or displaced. If the socket is also fractures, the surgeon will also repair this area during surgery. Repair of these areas will often involve stabilization of the hipbone using one or more screws.
Unfortunately, despite this surgical procedure, risks of complication exist. During the injury, blood supply to the head of the femur may have been compromised. Despite stabilizing the fracture area through surgery, this complication may cause the femoral head to flatten out over time. In such cases, the joint surface becomes irregular, which can cause a person to develop arthritis following surgery. This risk is higher for older patients.
In some cases where this risk is high, partial or total hip replacement may be recommended.
Intertrochanteric Hip Fracture Treatment
This type of hip fracture is often treated surgically by implanting a hip screw, which is fixed to the outer edge of the bone to allow for impaction and compression of the fracture area. This is intended to increase stability and foster healing.
In some cases, an intramedullar nail is used. This impaction devise is implanted directly into the bone marrow canal via an opening in the top of the greater trochanter. Additional screws may also be used.
Subtrochanteric Fracture Treatment
As with some intertrochanteric fractures, subtrochanteric fractures are often managed with the intramedullary nail and additional screws, such as interlocking screws, or plates.
If a plate is used, it typically has a series of screws that enter the femur from its outer edge. A single large screw will go through both the neck and head of the femur and functions much like a compression hip screw. Additional screws on the plate attach to other areas of the bone to stabilize and hold it in place.
After Hip Fracture Surgery
Following surgery, a patient will either go home or remain under medical care. In some cases, a blood transfusion will be necessary. Blood thinning medications and antibiotics are often used following surgery as well.
Physical therapy often begins immediately following surgery, as patients will slowly be encouraged to get out of bed. Eventually, the goal of most rehabilitation is to help the patient regain strength to walk again, a process which takes an average of three months.
Following hip fracture surgery, most patients will regain most, if not all, of the independence, strength and mobility they enjoyed prior to suffering hip fracture.