Atrium Health Navicent Musculoskeletal Care Orthopedic Trauma

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Hip Fracture Program

What are Hip Fractures?

A hip fracture is a serious fracture of the femur that occurs in the upper part of the bone inside or around the hip joint. The term is used to describe different types of fractures that are often caused by osteoporosis and/or trauma, such as falls. The overwhelming majority of hip fractures are seen in elderly people with weakened bones. However, people that do not have weakened bones can have hip fractures. Usually, hip fractures in these people are from trauma or falls, like car or bicycle accidents or sports injuries.

How serious are Hip Fractures?

Hip fractures are one of the most serious types of fractures because the mortality within one year of people who suffer hip fractures is around 30%. Of course, most of these people are elderly and may pass away from other, unrelated causes. However, a significant number of hip fracture patients do pass away from complications related to the fracture, such as pneumonia or urinary tract infections.

Symptoms of a Hip Fracture

If a patient has a large amount of pain in the hip area and typically cannot put any weight on the leg that side, this is a preliminary indication that there may be a hip fracture. If the leg on that side appears shorter and rotated in an unnatural way, the doctor will order an x-ray to confirm the diagnosis of a hip fracture.

Risk Factors

A hip fracture can be associated with other conditions. The most common condition is osteoporosis. However, this is far from the only condition that can cause a hip fracture. Cancer of the hip bone also weakens the tissue considerably and makes hip fractures very likely. Infection of the bone is a less likely cause.

Diagnosis of a Hip Fracture

An x-ray usually makes the diagnosis of a fracture obvious. If the fracture is not detected by x-rays, a CT or MRI can be administered. If a hip fracture exists, surgical treatment is generally required, so the diagnosis must be certain. Before surgery can be performed, a full medical evaluation is carried out. This includes blood tests, ECGs, and chest x-rays. Doctors always want to make sure that the patient is medically optimized for this surgery, as it is a major operation that is often performed on an elderly person, and needs to be completed as safely as possible.

Prevention of a Hip Fracture

As previously mentioned, the vast majority of hip fractures happen when an elderly person falls. Thus, a great deal of the attention given to preventing hip fractures goes toward preventing these falls. Some other disorders can cause falls, including strokes and Parkinson's disease, for example. Treatment of conditions to prevent falls is the key in the prevention of hip fractures.

If a patient suffers one hip fracture, not only does the mortality rate increase, but so does the risk of falling again and perhaps fracturing the other hip. Physical therapy (PT), possibly in a rehabilitation facility, is often required after hip fracture surgery to optimize a patient's ability to return to pre-injury function. The prevention of future falls is directly addressed through PT working on strength, balance, and safety. A repeat fall and a fracture of the other hip, or one of the other extremities perhaps, is not uncommon; therefore, safety is extremely important.

One of the other important factors to address after surgery is also fracture prevention through treatment of osteoporosis. The patient will be directed to their primary doctors or other physicians that specialize in managing osteoporosis to help strengthen bones and prevent future fractures.

Treatment of a Hip Fracture

Hip fractures can be treated by either repairing the fracture or replacing the bone. More than half of hip fracture cases are treated with the implantation of an artificial hip joint. The surgery is a major physical and mental stress, especially on senior citizens. A major objective of hip surgery in the elderly is to enable early weight bearing and mobilization. This immediate ability helps prevent many complications associated with immobilization (such as bed sores, respiratory and/or gastrointestinal compromise, pneumonia, blood clots, or urinary tract infection).

Types of Hip Fractures

Intertrochanteric Femur Fracture

Intertrochanteric femur fractures occur approximately three to four inches from the hip joint. This type of fracture is typically fixed in two ways. One method is using a large screw that crosses the fracture and is attached to a plate secured to the side of the femur bone. This plate and screw method stabilizes the fracture while it heals over time. The other method also uses a screw to cross the fracture, but it is incorporated into a rod that is placed in the center or hollow canal of the femur bone. These two methods preserve the patient's own "ball" of the hip joint and typically enable immediate weight bearing after the surgery.

Femoral Neck Fracture

A femoral neck fracture is located just under the ball of the hip socket. If the fracture is impacted the pieces are not separated, one way of fixing the fracture is by placing three screws across it through a small incision. This is called Percutaneous Screw Fixation.

If the fracture pieces are separated, replacing the ball is often needed to get the best outcome, and that can be accomplished by performing a total hip replacement (total hip arthroplasty, where the ball and socket of the hip joint are both replaced) or a half hip replacement (hemi-arthroplasty, where the only the ball of the hip joint is replaced). In all of the above mentioned treatments for femoral neck hip fractures, immediate weight bearing is typically expected after surgery.

*Navicent Health Hip Fracture Program

As described above, a hip fracture is a serious injury because it can increase a patient's mortality risk, is associated with other complications (such as pneumonia, or blood clots, or urinary tract infections), and can lead to future injuries (such as fracturing the other hip through another fall). Therefore, the Navicent Health Hip Fracture Program was developed to minimize all of the unwanted complications just mentioned and optimize the restoration of pre-injury function. This is accomplished by:

  • Efficient and thorough medical optimization before surgery and restoring ambulation as quickly as possible
  • Minimizing the time unable to ambulate decreases complications
  • This is accomplished through a team approach throughout the hospital stay. The hospitalist physician, orthopaedic surgeon, anesthesiologist, physical therapist, and discharge planner, for example, work together as a coordinated unit to take care of a patient's hip fracture from presentation to discharge. After surgery, many patients go to a rehabilitation facility to assist in strengthening and increasing mobility. The patient, his/her family, and the healthcare team will work together to determine the best next stage towards recovery.
  • A main objective is to minimize the total length of stay for a patient, thereby decreasing the risk of complications and readmission; yet, most of all maximizing patient outcome and functional recovery.