Hip Fracture

What is hip fracture?

A hip fracture is a break in the upper portion of the femur (thigh bone), near the hip joint. It typically occurs in the femoral neck (just below the ball of the ball-and-socket hip joint) or the intertrochanteric region (just below the femoral neck). 

In younger patients, hip fractures are commonly cause by falls or high-impact accidents. In older patients, they are often associated with osteoporosis.

What are the symptoms of hip fracture? 

People with hip fractures typically feel severe pain in the groin and upper thigh which often prevents them from sitting or moving normally.  

This pain may be accompanied by bruising or swelling in the same area, as well as a visible foreshortening or external rotation of the affected leg. 

 

What causes hip fracture?

Hip fractures can be caused by a variety of factors. These include

  • Impact trauma: fractures resulting from falls are particularly common among elderly patients, while fractures resulting from car or motorcycle accidents are also typical. 
  • Osteoporosis: a major contributing factor to hip fracture among elderly groups, osteoporosis leaves bone severely weakened and susceptible to fracture, even in the event of relatively minor injury.
  • Cancer: cancer cells within the bone can disrupt the normal processes of bone formation and resorption, resulting in weakening and fragility. Primary bone cancers such as osteosarcoma weaken the bone structure directly, while chemotherapy and radiotherapy can both impact bone strength over time.: 
  • Infection: bone infection, like osteomyelitis, can weaken the femur and pelvis by destroying bone. Septic arthritis can also damage bone and erode the bone surface. Infection also impairs the body’s ability to repair damaged bone. 
  • High impact activities: stress fractures are common among those engaging in high-impact activities or intense physical exercise and may be exacerbated by restricted eating.

Less commonly, fractures may occur without obvious injury. These spontaneous fractures often affect the femoral neck and typically occur among the elderly and the very active young.

What non-surgical treatments are available for hip fracture?  

Most hip fractures will require immediate surgical treatment within 48 hours of injury. 

Non-surgical treatments are typically reserved for patients who would struggle to fully recover following surgery, or whose surgery may be delayed by other health considerations. Rarely, nondisplaced fractures may be managed without surgery. 

In these cases, treatment is focused on bone healing and the avoidance of further injury. This may be done through bed rest and traction, as well as dietary support and physical therapy, alongside pain management. 

What surgical treatments are available for hip fracture?  

Where patients are considered suitable for surgery, a variety of treatment options are available. These include: 

  • Internal fixation: this involves the implantation of metal screws, plates or rods to stabilise the bone while they heal. It is commonly used for femoral neck and intertrochanteric fractures. 
  • Hemiarthroplasty (partial hip replacement): this involves the head of the femur being replaced with a prosthetic implant, while the socket of the hip joint is left intact.
  • Total hip arthroplasty (total hip replacement): this involves replacemenyt of both the head of the femur and the socket of the hip joint with prosthetic components. This is usually perfomed when the damage to the hip is very significant, or where the fracture is severe and internal fixation is unlikely to be successful.

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