Atrium Health Navicent Musculoskeletal Care Orthopedic Trauma

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Hip Fractures

What are Hip Fractures?

A hip fracture is a serious fracture of the femur that occurs in the proximal end of the bone inside or around the hip joint. The term is used to describe four different types of fractures that are often caused by osteoporosis. The overwhelming majority of hip fractures are seen in elderly people with weakened bones. However, people that do not have weakened bones do have hip fractures from time to time. Usually, hip fractures in these people are from high-impact trauma, 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.

Symptoms of a Hip Fracture

If a patient has a large amount of pain in the hip area and 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 is likely to be associated with another condition. 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 it does not, a CT or MRI can be administered. If a hip fracture exists, surgical treatment is generally required, so the diagnosis must be certain. After the fracture is diagnosed but before the surgery, a full medical investigation 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.

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 disease. Early and vigorous treatment for these conditions can prevent many falls that may cause hip fractures. In addition, a disease called cervical spondylosis myelopathy is quite common amongst patients that present with a hip fracture. The interaction between this disease and falls in the elderly is largely unknown, and research is currently being conducted into this relationship.

Physical therapy (PT), possibly in a rehabilitation facility, is required after hip fracture surgery to optimize a patient's ability to return to pre-injury function. Additionally, 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 Bone Health Clinic here at NavicentHealth is comprised of medical doctors specializing in 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 (bed sores, respiratory and/or GI compromise, pneumonia, blood clots, UTI).

Possible Complications of a Hip Fracture

The main potential complications of hip fracture surgery are bleeding, infection, implant failure, and fracture nonunion. It can happen up to 20% of the time, depending on the type of hip fracture. One related condition is called "malunion" which means the bones have healed, but not in proper position. The other complication is avascular necrosis, which means the blood supply to the tissue around the hip has been compromised leading to the death of the bone in the femoral head.