The acetabular joint, or hip joint, is the largest ball and socket joint in the body. When a break or crack in the bone occurs in the femur or acetabulum (hip bone) it is called a hip fracture, or broken hip.
A hip fracture commonly occurs in the elderly during even a seemingly harmless fall when the hip bones are weakened (i.e. in the case of osteoarthritis) and often requires hospitalization. A fracture may also be caused by a hard hit in a car accident or during a sporting activity. Fractures and hip dislocations often occur together.
A fracture in the hip can refer to a break in the femoral head or to the hip socket itself. The degree of fracture can range from a small (grade 1) fracture, to a serious (grade 4) fracture. Fractures to the femur are categorized as femoral neck fractures or intertrochanteric hip fractures. Femoral neck fractures affect the area just below the femoral head (top of thigh bone).
Besides the fracture of bone, damage to arteries leading to the femoral head is justifiably serious concern as it can limit the necessary blood supply. Without healthy blood flow delivering the necessary nutrients and oxygen, complications such as hip osteonecrosis (also called avascular necrosis) can result. Osteonecrosis can lead to the bone marrow dying, weakening the femoral head and leaving it at risk of collapsing. Repairing the fractured bone and arteries is important to maintain the blood flow to the head of the femur.
Intertrochanteric hip fractures affect the area well below the femoral head, and as a result, are much easier to heal. This is because the fractured area is easier to treat because of its location, and blood supply to the bone is not as much of a concern.
Symptoms of a Hip Fracture
- Severe pain in the hip area
- Lower back pain
- Difficulties walking, standing or moving or complete immobility
- Swelling, stiffness and bruising in the hip area
- A visible shortening and outward turning of the leg on the affected side
- A visible change in the appearance of the hip joint
Risks and Causes of a Hip Fracture
- Osteoporosis or weakened bones - women are at greater risk as they are more prone to osteoporosis
- Age - 90% of hip fractures occur in people over age 60
- Factors that may increase the risk of a fall - dementia or an unsteady gait
- Factors that may cause bones to weaken - intestinal disorders that affect your vitamin and mineral absorption, osteonecrosis, an overactive thyroid, smoking, excessive alcohol and caffeine consumption, lack of physical activity
- Weakness in the hip muscles due to inactivity
Tests for Hip Fractures
Your doctor will perform a physical exam and request an x-ray to diagnose a hip fracture and determine the type of treatment that you need. Your doctor may do an MRI to see if there is additional damage to the soft tissue of the hip that requires treatment.
Hip fractures almost always require surgery. The type of surgery will depend on the severity and location of the fracture as well as the age of the patient. A hip replacement may be performed with patients over 60 years of age who are less active. Historically, hip replacements have tended to wear out in more active patients so were generally avoided in young people and more active elderly patients. Hip replacements (both the components and the surgeries) are getting better on a continual basis, and are becoming a more viable option to patients that would not have been well served by such a replacement in the past.
Femoral Neck Fractures of the Hip - Hip Pinning Surgery
If the surgeon opted NOT to do a hip replacement for a patient with a fracture in the femoral neck, the patient will most likely undergo "hip pinning". Hip pinning involves placing several screws across the fractured femoral head, and is usually only done in younger patients, or if the fractured bones are well aligned. Even when this procedure is done properly, a partial or full hip replacement may be necessary in the future. Hip pinning is basically intracapsular repair (see image below for reference)
Intertrochanteric Hip Fractures- Metal Plate Surgery
Intertrochanteric hip fractures are usually repaired with surgery by adhering a metal plate to the shaft of the femur with several small screws. X-rays are used to get the proper alignment, and then an 3" incision is made. The surgeon will affix the metal plate along the length of the fracture, and secure it with screws.
Hip hemiarthroplasty is a term that describes a partial hip replacement. The surgeon removes the femoral head and replaces it with a metal "ball" that will sit in the hip socket. This procedure is required when the hip fracture is especially mis-aligned or severely fractured.
Treating a Hip Fracture
In case you were not sure, a hip fracture is a serious medical emergency! Immediate treatment is necessary, so get to the hospital quickly.
With a hip fracture, it is pretty much a given that you will be undergoing surgery. Significant secondary damage will probably have occurred from the fracture, including complications to nearby nerves, blood vessels and protective cartilage in the joint. Most probably, the ligaments surrounding the hip joint will have been damaged - perhaps strained or even ruptured. All of these issues will determine the length of your rehabilitation. In some cases, damage to blood vessels near the hip joint can cause a loss of blood supply to the bone - this is known as osteonecrosis.
In nearly all cases of post fracture recovery, your physician, physical therapist or surgeon will recommend a treatment recovery plan for you that will include Rest, Ice, Compression, Elevation, Stretching - basically an outline of conservative treatments. Protocols used in recovery from a hip fracture basically the same protocols found in hip post surgery recovery. To view more information about post operative recovery/rehabilitation of the hip, click here.
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