Hip Fractures Treatment

Hip fractures are serious injuries that commonly affect older adults but can also occur in younger individuals due to accidents or falls. This overview will explain hip fractures, the different types, how often they occur, and why it’s crucial to get prompt medical attention if you suspect a hip fracture.

Overview of Hip Fractures

A hip fracture is a break in the upper part of the femur bone (thigh bone) close to the hip joint. There are two main types of hip fractures:

Definition and Types

Intracapsular – This type of fracture occurs at the level of the neck of the femur within the hip joint capsule.
Extracapsular – Fractures that occur outside the joint capsule, often involving the area below the neck of the femur.

Incidence and Risk Factors

Hip fractures are quite common, especially among older adults, and their incidence increases
.
Risk Factors – Older age, osteoporosis (weak bones), falls, decreased mobility, certain medications (like steroids), and chronic health conditions (such as arthritis) increase the risk of hip fractures.

Importance of Prompt Treatment

Getting timely medical attention for a suspected hip fracture is crucial for several reasons:

Prompt treatment reduces the risk of complications like blood clots, pneumonia, bedsores, and muscle atrophy.
Early intervention often leads to better outcomes, including faster recovery and improved mobility.
Quick diagnosis and treatment can help manage pain more effectively.

Diagnosis

Diagnosing a hip fracture involves a combination of clinical evaluation and imaging tests to accurately assess the injury.

Symptoms and Physical Examination

Symptoms – Patients typically experience sudden and severe pain in the hip or groin area, accompanied by difficulty or inability to bear weight on the affected leg.
Physical Examination – Doctors will perform a thorough examination of the hip joint, looking for signs of swelling, bruising, deformity, or limited range of motion.

Radiological Imaging (X-rays, CT scan)

X-rays – This is usually the first imaging test used to diagnose hip fractures. X-rays can show the location and extent of the fracture.
CT Scan (Computed Tomography) – In some cases, especially for complex fractures or when more detailed imaging is needed, a CT scan may be ordered. CT scans provide a three-dimensional view of the fracture, which helps plan treatment.

Initial Management of Hip Fracture

initial management of a hip fracture involves addressing pain, immobilising the affected hip, and assessing neurovascular status to ensure no complications arise from the injury. Additionally, a thorough preoperative assessment helps the medical team prepare for surgical intervention by understanding the patient’s medical background and determining the safest approach to anaesthesia. Early and comprehensive care sets the stage for successful treatment and recovery from a hip fracture.

Surgical Treatment

When it comes to treating hip fractures, surgery is often necessary to restore mobility, stability, and overall function of the hip joint. The decision for surgical intervention depends on various factors, including the type of fracture and the patient’s overall health and functional status.

Intracapsular Fractures – These often require surgical intervention, especially if the fracture fragments are displaced, or there is a risk of avascular necrosis (loss of blood supply) to the femoral head. Extracapsular Fractures – Surgery is typically recommended for unstable extracapsular fractures to stabilise the bone and facilitate proper healing.

Surgery may be considered based on the patient’s overall health and ability to tolerate anaesthesia and rehabilitation. Factors such as age, comorbidities (e.g., heart disease, diabetes), and functional independence play a role in decision-making.

Surgical Options

Hip Pinning (Internal Fixation)

This involves stabilising the fracture using metal screws, plates, or rods to hold the broken bones in place. Hip pinning is commonly used for intracapsular fractures, especially if the fracture is minimally displaced.

Hip Replacement (Partial or Total)

Partial Hip Replacement (Hemiarthroplasty) – Involves replacing the femoral head with a prosthetic component while preserving the patient’s own acetabulum (hip socket). This is often considered for complex intracapsular fractures.
Total Hip Replacement (Total Hip Arthroplasty) – Involves replacing the femoral head and the acetabulum with prosthetic components. This is typically recommended for certain extracapsular or severe arthritis-related fractures.

Potential Complications and Risk Mitigation

Surgical procedures for hip fractures carry certain risks, including infection, blood clots, nerve injury, and implant-related complications. Risk mitigation strategies include preoperative optimisation (e.g., managing chronic conditions), intraoperative techniques (e.g., antibiotic prophylaxis), and postoperative care (e.g., early mobilisation, deep vein thrombosis prophylaxis).

Postoperative Care

After undergoing surgery for a hip fracture, a structured and comprehensive postoperative care plan is essential to promote healing, prevent complications, and optimise functional recovery. Immediate Post-op Period

Pain Management

Effective pain control is crucial for patient comfort and early mobility. Medications such as opioids, NSAIDs, and acetaminophen are commonly used. Pain management strategies may include local anaesthetic techniques and non-pharmacological approaches (e.g., ice packs, positioning).

Early Mobilization and Physical Therapy

Encouraging early mobilisation, under the guidance of physical therapists, helps prevent complications such as joint stiffness, muscle weakness, and bedsores. Patients are assisted with safe movements and exercises to promote circulation and restore function.

Prevention of Complications

Thromboprophylaxis – Measures to prevent blood clots (deep vein thrombosis – DVT) are essential. This may include blood-thinning medications (anticoagulants), compression stockings, and early mobilisation.
Respiratory Management – Proper respiratory care, including deep breathing exercises and early ambulation, helps reduce the risk of respiratory complications like pneumonia.

Rehabilitation

Rehabilitation aims to restore mobility, strength, and independence in activities of daily living (ADLs). Specific goals include improving joint range of motion, muscle strength, balance, and functional capacity. The rehabilitation program is tailored to each patient’s needs and recovery trajectory. It typically starts soon after surgery and progresses gradually based on the patient’s tolerance and response to therapy. The intensity of rehabilitation increases over time, transitioning from basic exercises and assisted mobility to more challenging activities and functional training.

Follow-up and Monitoring

Imaging Follow-up – Periodic imaging (e.g., X-rays) may be performed to assess the healing progress of the fracture and the stability of surgical implants. Assessment of Healing and Functional Recovery – Regular follow-up appointments with orthopaedic surgeons and physical therapists are scheduled to monitor healing, evaluate functional recovery, and adjust the rehabilitation plan as needed. Functional assessments may include tests of mobility, balance, and ADLs to track progress and set new rehabilitation goals.

Prognosis and Outcomes

The prognosis and outcomes following a hip fracture can vary depending on several factors, including the patient’s age, overall health, the type and severity of the fracture, and the effectiveness of treatment and rehabilitation.

Factors Affecting Prognosis

Age and Health Status – Older age is a significant risk factor for complications and slower recovery after a hip fracture due to reduced bone density, decreased muscle strength, and higher prevalence of chronic health conditions.
The overall health status of the patient, including preexisting medical conditions (e.g., diabetes, heart disease), can impact recovery and the ability to tolerate surgery and rehabilitation.
Type and Severity of Fracture – The location and extent of the fracture influence treatment options and outcomes. Intracapsular fractures, particularly displaced ones, may have a higher risk of complications like avascular necrosis (bone death) of the femoral head.
Extracapsular fractures, especially unstable ones, may require more extensive surgical procedures and have longer recovery times.

Functional Outcomes and Quality of Life

Functional Outcomes – Rehabilitation is critical in restoring mobility and function after a hip fracture. Early mobilisation and comprehensive physical therapy can help regain strength, balance, and independence in activities of daily living (ADLs).
Quality of Life – Hip fractures can have a significant impact on quality of life, especially in older adults. Factors such as persistent pain, decreased mobility, and limitations in social and recreational activities may affect overall well-being.
Complications – The occurrence of postoperative complications (e.g., infection, implant failure, persistent pain) can also influence functional outcomes and quality of life following a hip fracture.

Key Points for Prognosis and Recovery

Early Intervention – Timely diagnosis, appropriate surgical treatment, and comprehensive rehabilitation contribute to better outcomes.
Patient Engagement – Active participation in rehabilitation programs and adherence to medical advice are crucial for maximising recovery and functional outcomes.
Long-Term Follow-up – Regular monitoring and follow-up with healthcare providers are important for detecting and addressing any lingering issues or complications.
Multidisciplinary Care – Collaboration between orthopaedic surgeons, physiotherapists, occupational therapists, and other healthcare professionals ensures a holistic approach to recovery and rehabilitation.

Dr Lee is an experienced orthopaedic surgeon who specializes in

Hip Fractures Treatment

He will assess your condition and advise the best form of treatment for your condition. With proper treatment, patients can look forward to a full and quick recovery without complications.

Dr Lee Eu Jin

CONSULTANT ORTHOPAEDIC SURGEON
JOINT REPLACEMENT SPECIALIST AND SPORTS SURGEON

MBBS (London), MRCS (Edin),
M.Med (Orth), FRCS (Orth & Trauma)

Dr Lee Eu Jin is a Consultant Orthopaedic Surgeon with a subspecialty interest in hip and knee surgery.