- Causes for Hip Fracture
- Symptoms of Hip Fracture
- Conservative therapeutic approaches
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The hip is a ball-and-socket joint made up of the head of the thigh bone or femur that acts as the ball and fits into the rounded socket of the hip bone or acetabulum. The neck of the femur is the region just below the ball of the hip joint.
Fractures to the femoral neck can completely or partially disconnect the femoral head from the rest of the femur. Hip fractures may be either displaced, where the bone is moved out of its original position, or non-displaced, where there is no instability of the bone. These fractures may disrupt the blood supply to the fractured portion of the bone. In cases of badly displaced hip fractures, the de creased blood supply prevents these fractures from healing.
- Minor fall or twisting of the hip in the elderly
- Osteoporosis or degradation of bone
- Stress on the femoral neck
- Strenuous activity or high-impact trauma to the hip in young people
- Radiating pain to the knee
- Inability to bear weight
- Shortening or sideways rotation of the affected leg
- Increased pain in the hip during rotation of leg
- Swelling on the side of the hip
Diagnosis is based on your age, the description of your symptoms and occurrence of an accident. Your doctor may order an X-ray to diagnose your hip fracture. Your doctor may also perform other imaging tests such as the magnetic resonance imaging (MRI), and computer tomography (CT) scan to detect the fracture. Radiographic image of a broken shenton’s curve, which shows the relationship of the femoral head to the acetabulum, indicates a hip fracture.
Treatment of the hip fracture will depend on your age and the extent of displacement of the fractured bone.
Conservative therapeutic approaches are suggested for uncomplicated fractures and include bed rest for few days. You may be slowly introduced to a physical rehabilitation program after 2 or 3 days. Your doctor may prescribe medications to prevent clotting, pain and infection.
However, the hip fracture is rarely stable to manage with only conservative therapy and may necessitate surgery.
Surgery is a necessity in most cases.The surgical procedures are performed under general or spinal anesthesia.
- Hip Pinning is recommended if your facture is minimally displaced and you have sufficient bone density. Your surgeon will make a small incision on the outside of your thigh and pass several screws to stabilize the broken bones.
- Hip Hemiarthroplastyor Partial Hip Replacement is suggested if you have a displaced fracture. Your surgeon will make an incision over the outside of the hip, remove the femoral head and replace it with a metal implant. The socket will not be replaced in this procedure.
- Total Hip Replacement is recommended if you have had arthritis of the hip even before the fracture. Your surgeon will replace the femoral head as well as the socket of the hip joint with artificial metal implants.
A fracture is a condition in which there is break in the continuity of the bone. In younger individuals these fractures are caused from high energy injuries, as from a motor vehicle accident. In older people the most common cause is weak and fragile bone.
- Distal Femur Fracture: The distal femur is part of the femur bone that flares out like the mouth of the funnel. A distal femur (top part of knee joint) fracture is a break in thighbone that occurs just above your knee joint.
- Femoral Shaft Fracture: A femoral shaft fracture is a break that occurs anywhere along the femoral shaft, long, straight part of the femur.
- Fractures of Proximal Tibia: A proximal tibial fracture is a break in the upper part of the shin bone or tibia. Proximal tibial fractures may or may not involve the knee joint. Fractures that enter the knee joint may cause joint imperfections, irregular joint surfaces, and improper alignment in the legs. This can lead to as joint instability, arthritis, and loss of motion. These fractures are caused by stress or trauma or in a bone already compromised by disease, such as cancer or infection. Proximal tibia fractures can result in injury to the surrounding soft tissues including skin, muscle, nerves, blood vessels, and ligaments.
- Tibial Shaft Fractures: A tibial shaft fracture is a break that occurs along the length of the tibia or shin bone (larger bone of the lower leg) between the knee and ankle joints. These fractures can occur while playing sports such as soccer and skiing.
Diagnosis is made through your medical history, physical examination, and other diagnostic imaging tests. X-rays are taken to know whether the bone is intact or broken. X-rays are also helpful to know the type and location of fracture. Your doctor may also recommend a computerized tomography (CT) scan to know the severity of fracture.
Treatment options include non-surgical and surgical. Non-surgical treatment involves skeletal traction and use of casts and braces. Skeletal traction involves placement of pin into the bone in order to realign broken bones. Surgery involves internal fixation and external fixation.
- Intramedullary Nailing: In this procedure a specially designed metal rod is placed into the marrow canal of the femur. Then the nail is passed on to reach the fracture site and keep it in place. The rod is secured in place with screws at both ends.
- Plates and Screws Fixation: In this procedure your surgeon will reposition the broken bone ends into normal position and then uses special screws or metal plates on the outer surface of the bone to hold the bone fragments in place.
During the procedure, metal pins or screws are inserted into the middle of the femur and tibia and are attached to a device outside the skin to hold bone fragments in place to allow alignment and healing.
If your bone is fractured in many pieces, a plate or rod is fixed at both ends of the fracture to maintain the overall shape and length of the bone in place while it heals. In elder patients where fracture healing delays, a bone graft taken from the patient or tissue bank may be used to form callous. In severe case, the bone fragments are removed and the bone is replaced with a knee replacement implant.
The most common complications of surgery include infection, knee stiffness, delayed bone healing, and knee arthritis.