HIP FRACTURES

Hip Fractures

Hip fractures are commonly referred to the fractures of the proximal part of the thigh bone which forms one side of the hip joint. Patients with hip fractures may present in a variety of ways, ranging from a 30 year old man in a serious state after a high-speed motor vehicle accident to an 80 year old woman reporting hip pain after a trivial fall.

Osteoporosis in the elderly contributes to most of these fractures.  Majority of the hip fractures in elderly occur either along the neck of femur or along the trochanteric region of the femur which are mechanically weak. With appropriate care and attention to life style, some of these fractures can be prevented.

 Symptoms and signs:

• Severe pain in hip or groin area
• Inability to move the leg after a trivial fall, twisting injury, slip or a fall
• Inability to stand or put weight on that leg
• Stiffness, bruising and swelling in and around the hip area
• Shorter leg on the side of injury
• The leg and foot may turn outward

Risk factors

• Being female (twice as likely to fracture their hips as men after menopause)
• Your family history-being thin or tall or having family members who had fractures later in life.
• Poor eating habits. Not getting enough calcium and vitamin D.
• Not being active. Weight-bearing exercise, such as walking, can help keep bones strong.
• Smoking.
• Medical conditions that cause dizziness or problems with balance, or conditions such as arthritis that can interfere with steady and safe movement.
• Taking certain medicines that may lead to bone loss. Eg : steroids

Treatment Options

Surgery: Almost always the best option for treating hip fractures. Doctors typically use nonsurgical alternatives, such as traction, only if you have a serious illness that makes surgery too risky.

Femoral neck fractures: Doctors repair this type of fracture by one of these methods:

• Replacement of part of the femur:  removing the head and neck of the femur and replace them with a metal prosthesis. This is known as hemiarthroplasty.
• Total hip replacement: This procedure involves replacing your upper femur and the socket in your pelvic bone with prostheses. Total hip replacement may be a good option if arthritis or a prior injury has damaged your joint, affecting its function prior to the fracture.
• But in a relatively young patient, we try to avoid replacing the upper part of thigh bone by fixing the fracture with screws.

Trochanteric fractures: This type of fracture is fixed with a metal screw with side plate assembly (hip compression screw) or sometimes we use a metal rod – nail, in to the bone with screws in to the neck and head of femur.

Physiotherapist can help you to walk again after surgery, if you are fit, from the very next day after the operation.

Complications: They are largely due to relative immobility of the patient

1. Blood clots in the veins 
2. Fat embolism: fat globules from the fracture site entering blood circulation and reaching lungs.
3. Electrolyte imbalance
4. Bed sores
5. Chest infection

Prognosis:

Most of the patients do very well after a successful surgery. It is important to get the correct treatment without any delay. Prior health problems, debility, any complications following surgery and forced prolonged bed rest after surgery may lead to a poor outcome.