Hip fracture

From ArticleWorld

A hip fracture is a breakage of the proximal femur bone in areas near the hip joint. Hip fractures are not uncommon in the elderly and especially in women with osteoporosis. A young person can get a fractured hip although it is usually from a severe accident or a “pathological fracture”, in which a bone tumor or damaged blood supply to the hip causes the bone to break.

Types

Hip fractures can be of two primary types. A femoral neck fracture involves a fracture line that occurs across the base of the ball joint aspect of the femur. It can be completely nondisplaced (type 1) and thus easier to repair or completely displaced so that none of the bony fragments come in contact with one another (Type 4). Several lesser degrees of displacement are described as well. The risk of femoral neck fractures over other kinds of fractures is that the blood supply to the femoral neck is not as adequate as the rest of the bone so that poor healing or a type of bone cell death called avascular necrosis is possible.

The most common fracture type seen in the hip is called an intertrochanteric fracture. This involves a break that extends from the higher greater trochanter of the femur down to the lower lesser trochanter. This fracture leaves both fracture segments with adequate blood supply so that the risk of bony necrosis is considerably less. The fracture, however, can be nearly vertical leading to problems with stability.

Treatment

The treatment of most hip fractures involves internally operating on the femur. Unfortunately, most hip fracture patients are elderly and have multiple other health problems making surgery more risky.

The majority of hip fractures are treated by cutting out the top portion of the femur, including the fractured area, and replacing the entire hip with an artificial metal and plastic hip. Sometimes only the femur head is replaced, while other times, the acetabulum is replaced as well so that the joint moves more smoothly.

In some cases, the surgeon simply uses screws and/or plates to repair the damaged bone. While this is less invasive, the risk for incomplete healing and reinjury is higher. In the case of femoral neck fractures, repairing the break without replacing the femoral head can result in poor healing from lack of adequate circulation to the fracture segments.

In some cases, no surgical treatment is done on patients with a hip fracture. This is usually because the patient is too frail for surgery and is not expected to walk again. Without prolonged immobilization or surgery, the likelihood of regaining the ability to walk is slim.

Prognosis

A fractured hip is often something that an elderly person does not survive. Many will survive the surgical repair but will later suffer from complications such as blood clots, infections and pneumonia. Of elderly people who sustain hip fractures, at least 25% will die within a year.