Hip Fracture

Hip Fracture

What is it?
A hip fracture is a break in the upper portion of the thighbone (Femur). It affects the ball part of “ball-and-socket” hip joint called Femur Head and the parts immediately below it:
• Femur neck
• Intertrochanteric area
• Subtrochanteric area
Femur neck fractures are the most common types of hip fracture.
Most are as a result a simple bone on ground level of weakened bone by osteoporosis in the elderly.
In the young, it is a result of a high energy event as in a car crash or fall from height.
• Pain localized to groin and upper part of the thigh is the typical symptom.
• Unable to move the upper part of leg or knee.
• Outward rotation of the foot.
• Difficulty to stand and walk on the fractured leg.

Xray of the pelvis shows most of the fracture, CT and MRI might also be requested in selected cases.

Most hip fractures require surgery within 1-2days of the injury. Some may be too sick to tolerate surgery, and a very small group could be treated without surgery.
The aim in treating these fractures is a prompt surgery to get the patient out of bed as soon as possible to help prevent medical complications such as bed sore, blood clots, pneumonia, heart attacks and death.
Timing of surgery depends on how quick we can get the associated medical condition can be optimized for surgery. Having surgery as soon as possible will lessenthe risk of complication. Hence, we will do all what is possible to get you ready for surgery within 48 hours, but depending on the associated problems you may have sometimes it may take longer. It is better you are appropriately optimized than to rush to surgery.

Treatment depends on:
• Type of fracture
• Location of fracture
• Age of the patient
• Activity level of the patient
• Condition of the patient
Femur neck Fracture
This is by far the commenst location of hip fractures.
Most need surgical fixation. Patients that were not wlking before fracture or have severe medial problems may be considered for nonsurgical treatemnt.

In the younger patients, it is desirable to preserve the natural femoral head when ever possible. We perform fracture fixation using various techniques. This involves putting the bone back into place, by either making incision over the hip joint, or with a closed means, and then holding the bone with screws or other metal fixations. This carry the risk of failure to heal. Even if the fracture does heal, a condition called avascular necrosis may develop in the head. However, is is felt best to try to preserve a younger patient’s natural hip joint. When these complication occur, hip replacement is the salvage option.

In the aged population, treatment ranges from fixation for fractures that are not displaced to either partial (hemiarthroplasy) or total hip replacement for displaced fractures.

Dr Sami perfomrs minimal invasive fracture fixation or hip replacements as deemed necessary after indepth discussion on various treatemnt options with you and your family. Minimal invasive treatment has revolutionized the way we handle these injuries as recovery is quicker with shorter hospital stay and lesser complications.

See Dr Sami’s video below to learn more.

Intertrochanteric fracture
Intertrochanteric fractures occur below femur neck between the lesser and greater trochanters (the bump you feel on the side of your hip).

These are treated surgically with what we call dynamic hip screw, angle blade plate or intramedullary nail.

Dynamic hip screw and angle blade plates are fixed to outer surface of the upper thigh bone with metal part going in to the femoral head and neck.

Intramedullary nail is placed into the marrow canal of the bone through an opening made at the top of the greater trochanter. One or more screws are then placed through the nail and into the femoral head as well as on the most distant part of the upper thigh bone.

Subtrochanteric Fracture
Subtrochanteric fractures involve the upper part of the shaft of the femur, just below the hip joint.
These are treated surgically with what we call dynamic hip screw, angle blade plate or intramedullary nail depending on the nature of the fracture, bone quality, activity level and weather there is an underlying problem with the bone.

Femur Head Fractures
Femur head fractures usually result from a high-velocity event. It can be associated with hip joint dislocation and / or hip socket fracture.
Treatment options include:

• If not displaced or located in non wight bearing area of the femoral head, it can be treated without surgery.
• Fragement removal is considered if it is a small piece that gets traped in the hip joint surface or when it doesn’t involve a large part of the joint surface.
• Large fragemnt in a young active person, open reduction and fixation needs to be done.
• Large fragemnt in an older person, hip replacement- either partial or total hip arthroplasty is treatment of choice.

Compiled and written on June, 2021. By Dr. Samuel Hailu.

*Disclaimer:*The information contained herein is for educational purposes only. This should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your healthcare provider because of any information you read on this topic.