Hip Fracture Repair

Hip fractures in young people are typically the result of a traumatic event like an auto accident or a fall from a significant height. In older adults with osteoporosis (brittle bones), hip fractures are a frequent injury caused by a low energy fall from standing height, twisting, or tripping. Osteoporotic hip fractures cause disability and increase the risk of mortality within a year of the fracture.

Hip fractures cause significant pain in the groin and upper thigh. In the elderly, hip pain is often an indication that the hip is broken. Hip fractures usually require immediate (within 48 hours of the fracture) surgical repair. After surgery, getting the patient out of bed to sit or stand multiple times a day can prevent medical complications such as ulcers, blood clots and pneumonia. Rehabilitation is vital to a quicker recovery.

Suspected hip fractures are a medical emergency. In the hospital setting, the patient’s medical history will help identify other health conditions or treatments that may have led to the fall. The patient will receive an examination to evaluate their total condition. This may involve specialists like a cardiologist. In addition, the patient will be examined for other injuries and will receive x-rays to evaluate the bone injury severity. If X-Rays are not conclusive, an MRI scan will be performed to identify the fracture and to evaluate soft tissue injury. In severe bone injury, a CT scan can provide more detailed images of the fracture pattern.

A nondisplaced fracture is one in which the bones have not shifted position, often times considered a stable fracture. In contrast, a displaced fracture is one in which the broken bone ends have moved apart denoting an unstable fracture pattern. In other words, the bone is broken and the parts are not in alignment.

Ideally, based off the medical literature, surgery for hip fractures should be performed within 48 hours of injury to relieve pain and reduce the risk of complications. The exact procedure is based on the type and location of the fracture as well as the age and health of the patient.

Generally, there are three options: repair, partial hip replacement and total hip replacement.

• For a fracture of the neck of the femur that is stable, treatment is surgical stabilization with pins or screws placed into the bone. This stabilization procedure effectively holds the bone in place while it mends itself. Hip pining procedures prevent the bone from slipping out of position during patient movement or ambulation.
• When the fracture is displaced in older osteoporotic patients, the risk of damage to the blood supply is high. Damage to the blood supply delays healing and can lead to osteonecrosis, death of bone due to a lack of blood supply. Understanding the natural history of this injury, the surgeon may choose to perform a total or partial hip replacement allowing the patient to ambulate right away, thereby minimizing risks of immobility such as ulcers, blood clots and pneumonia. Partial or total hip replacements have a lifespan of 20-25 years, but this duration varies based on position of component placement and activity level of patient.
• When the fracture is displaced in young patients, surgical repair is often recommended immediately to prevent the need for a partial or total hip replacement. The goal is always try to preserve the hip now in order to minimize the number of surgical procedures in one’s lifetime.

Studies report that in elderly patients, early postoperative mobilization including weight bearing within 48 hours after surgery has a net positive impact on regaining functional mobility and reduces the length of the inpatient hospital stay. These positive factors increase the probability of discharge to home and lower the risk of complications following surgery.

In younger individuals, given the nature of traumatic injury causing the fracture, healing and rehabilitation can take several months. Most patients will require some form of weight bearing restriction with crutches, a walker, or cane to aid in muscle recovery and balance.

With proper treatment and rehabilitation, most people with a hip fracture can make a full recovery and return to their normal activities.