A B C D E F G H I J K L M N O P R S T U V W

HIP FRACTURE - FEMORAL NECK FRACTURE

What is a Hip Fracture ?

The hip joint connects the thigh bone (femur) with the pelvis. Despite the name hip fracture , the break is actually below the hip joint, at one of two places at the upper end of the thigh bone. Following a fall, severe pain occurs in the region of the hip, groin and thigh. Mostly it will be impossible to get up or walk. Very occasionally when the bone is cracked rather than completely broken, walking is possible although painful.

How does a Hip Fracture occur ?

Fracture occurs following a simple fall onto the hip, usually without any other injury. More rarely it can occur as a result of a road traffic accident, or with other major injuries. About one in eight women and one in twenty men will have such a fracture in their lifetime.

Why does a Hip Fracture occur ?

These fractures occur mainly in older people and particularly in women who have thinning of the bones. This thinning (or weakening) of bones is a natural part of ageing, but is worse in some people, especially women who have had their menopause earlier than usual. Osteoporosis and osteomalacia are two conditions which make the bone lose its strength, and make the femoral neck region more likely to fracture when a person falls. In younger patients with normal bones, much greater force is needed to cause such a fracture. Occasionally the thigh bone fractures because of the presence of a cyst or growth, which weakens the bone.

Treatment Involved for a Hip Fracture

Treatment is almost always by operation. This will allow you to get up and move about with minimum delay. Surgery is performed as soon as possible after admission to hospital, although other medical problems such as anaemia or heart trouble frequently need treatment before surgery is undertaken. Often a weight-and-pulley system is set up and attached to the leg with tapes. This process (traction) helps to reduce pain before the operation. A general anaesthetic is usual. A spinal anaesthetic is also commonly used which involves an injection into the lower part of the spine, deadening the nerves. Fractures near to the top of the thigh bone are generally treated by replacing the top completely by a metal fitting. However, in younger patients, this fracture type is treated by getting the bone ends together and fixing them with a number of screws. Occasionally these fractures may be managed by total hip replacement. With fractures lower in the thigh bone, the ends are manipulated into position and then fixed together using a metal plate and screws.

During Treatment for a Hip Fracture

After awakening from the anaesthetic, you will have found a drip tube for giving fluid and blood in one of your arm veins. Plastic drainage tubes are left in the wound at the end of surgery and are brought out through the skin, so that blood and other fluids can drain away harmlessly. After surgery the affected leg rests in a foam gutter, or over a pillow. Tablets or injections are readily available to deal with any pain. An x-ray is taken to check the position of the bones, screws and metal fittings. A physiotherapist will help and guide you once you get out of bed. Walking is usually begun with the aid of a walking frame. Depending on the type of fracture, the doctors will allow a greater or lesser amount of the weight to be carried by the affected leg. If no walking aid was used previously, you should be able to manage the stairs two weeks after surgery. You will be discharged home once you are able to manage to look after yourself, although more prolonged rehabilitation is sometimes necessary. Some people require sheltered or warden-controlled housing, particularly if mobility was previously poor, or if there are other medical problems. Complications occur in a number of patients. A catheter tube may need to be inserted into the bladder if difficulty passing urine occurs after surgery. This is removed once you are walking. Pneumonia or heart problems may develop and affect recovery. Blood clots in the veins of the legs are common, causing swelling. Sometimes, these clots travel to the lung, causing chest pain and coughing up of blood. These conditions may need treatment with blood-thinning injections or tablets (anticogulants). Quite often, preventive anticoagulant treatment will be started as soon as the patient with a hip fracture is admitted to hospital to reduce the risk of clot. Infection of the wound is rare. Antibiotics are often given to reduce this risk, particularly if the top of the bone is replaced or a hip replacement is performed. A dislocation of the hip may develop. This is more likely to occur if you sit on a very low chair or bend your hip up too far. It may also happen after a fall. The risk of dislocation is greatly reduced after the first 6 to 12 weeks. Another possible problem is that the fractured bones can move out of position again. This causes pain and shortening of the leg and may require re-operation. Sometimes the top of the thigh bone loses its blood supply after the operation, and therfore die (avascular necrosis). This complication may need to be treated by a total hip replacement.

After Treatment for a Hip Fracture

Pain should gradually decrease after surgery, and the ability to walk improves. The doctor should be contacted if there is redness or discharge from the wound, worsening leg swelling, shortening of the leg, or chest pain with shortness of breath. In the long term, the development of pain in the operated hip may call for a total hip replacement. Some doctors will advocate checking bone density to see whether bone weakness contibuted to the fracture. If so, long term drug treatment can lessen the severity of this problem, and has been shown to reduce the risk of a second fracture. In addition, it has been shown that certain forms of exercise training can reduce the risk of falling and thereby the likelihood of further fracture may fall by up to 30%.

If a Hip Fracture is Left Untreated

Non-operative treatment means that you would need to be in bed on traction for at least 6 weeks. Such treatment frequently results in a short leg which is turned out, and some fractures may not heal. Many medical problems such as blood clots, pneumonia and pressure sores occur in elderly patients who are confined to bed for this length of time.

Effects on Family of a Hip Fracture

Considerable support from family and friends, including help with shopping and housework, is necessary following discharge from hospital.