How are hip fractures treated?

Hip fractures are common in elderly individuals with osteoporosis that sustain falls. They are often associated with pain, deformity, and loss of function. These factors, as well as previous health status and prolonged immobilization associated with untreated fractures, place these individuals at significant risk of illness in the lungs, blood clots, bed-sores, and mortality. Therefore, these injuries require an operation by an Orthopaedic surgeon unless anesthesia is an absolute contraindication.

The type of operation that is performed depends on the type of fracture and fracture displacement. Non-displaced fractures through the neck of the femur (the connection of the thigh bone to the ball) and femoral neck fractures in younger individuals can often be treated with screws placed through the neck into the head.

Displaced femoral neck fractures are often treated with a hemiarthroplasty (half a hip replacement). In this method, the femoral neck and head are removed and replaced with a metal implant while the acetabulum (the socket) is left intact. In individuals with severe degenerative joint disease, a total hip arthroplasty (replacement of the neck, head, and socket) may be recommended by the treating surgeon. The reason a full or partial replacement is necessary in the case of these fractures is that the blood supply to the femoral head is often disrupted, making the bone prone to collapse (avascular necrosis).

Fractures through the intertrochanteric region (the top of the thigh bone) or through the subtrochanteric region (very top of the shaft) are often treated with what is called a cephalomedullary device. This device consists of a thick nail placed inside the thigh bone and a connecting screw that travels through the femoral neck to the head. Intertrochanteric fractures may also be treated with what is called a sliding hip screw which consists of a small plate and screws placed on the side of the thigh bone with a connecting screw that travels through the femoral neck to the head.

Even with a perfect operation, individuals treated for hip fracture are at significant risk of medical complications and mortality. Therefore, the best medicine for hip fractures is taking measures to prevent osteoporosis and falls before they occur.

The goal of hip fracture treatment is to reconnect the broken bone and hold it in place so the hip works properly until it has time to heal—about three months. Surgery within 24 hours is usually necessary to make this repair. If you must wait for surgery, the hip may be held in traction (using weights to extend the muscles around the hip).

If you have a femoral neck fracture in which the pieces are not displaced, the orthopedic surgeon may connect the bone with surgical screws. If the bone has moved well out of place, or if you are older and not active, your surgeon may replace the head of the femur with a metal device, a procedure called a hemiarthroplasty or partial hip replacement. Or the surgeon may perform a total hip replacement, if arthritis is present. If you have an intertrochanteric fracture, the doctor will stabilize the joint with screws and a device that holds the broken bone in place.

After surgery, it can take several months for the hip to heal completely. Initially, you'll use crutches or a walker, putting weight on the leg only as permitted by the doctor. How soon you can put weight on the leg depends on the type of pinning or other device used in the repair. The goal of rehabilitation is to get you back on your feet as soon as possible. To prevent another fall, your physical therapist will work to help you develop a secure, balanced gait and will suggest other safety measures. To help prevent a second fracture, you should be evaluated for osteoporosis and treated if necessary.

Your doctor may also prescribe a drug from a class of antiresorptive agents called bisphosphonates, which increase bone density by slowing the rate of bone loss.