Hip Fractures

Key information:

Important:

The information provided on this website is done so as a guideline to assist you in further understanding your surgical treatment and what to expect. Each patient’s treatment plan is tailored to their conditions so your rehabilitation may be quicker or slower than other peoples.

Please contact Dr Rodda for advice should you be concerned about any aspect of your health or recovery.


Overview

A hip fracture is a break in the upper quarter of the femur. The treatment option recommended by your surgeon will depend on the bones and tissue affected by the fracture. There are generally three types of fractures that can occur in the hip, and these commonly occur when the hip joint is injured by either a fall or blow.
The three types of fractures are:

  • Intrascapular – The fracture occurs within the capsule and occurs at the neck and head of the femur. The capsule is an envelope of soft tissue that contains the lubricating fluid of the hip joint. When this is impacted it can create a loss of blood supply to the bone.
  • Intertrochanteric – This fracture occurs between the neck of the femur and the lower bony prominence known as the lesser trochanter. Blood supply to fractured pieces in this area of the hip is generally better.
  • Subtrochanteric – Occurring further down the bone this fracture may cause the bone to be broken into several pieces.

In more severe cases, patients may present with more than one of the fractures mentioned above.

A fracture of any kind isn’t always the result of an impact. There can be increased susceptibility to fractures due to several reasons, such as; cancer, osteoporosis or stress injuries. These conditions can often make the hip bones brittle and weak, in some cases a fracture/break can be a result of just twisting the hip joint awkwardly.

A hip fracture will normally cause discomfort in the outer upper thigh or groin area particularly when attempting to flex or rotate. There may also be a visible disproportion in the length of the legs if the bone is completely broken.

Process

A diagnosis will be generally made based on the x-ray and potentially an MRI as fractures can sometimes being hard to see on an x-ray. Based on these results a diagnosis will be made and surgery or treatment will commence. Risks of surgery will be weighed against your health and a decision will be made as to which surgery is right for you. If surgery is not an option for you Dr Rodda make his recommendations for non-surgical treatment and monitor the progression of your injury.

If surgery is a suitable option, all applicable tests will be run to confirm your eligibility as well as any complications we need to be aware of. Most fractures require surgery and if not treated can lead to serious complication, so it is recommended patients proceed with surgical treatment as soon as possible.

Your anaesthesia option is another element Dr Rodda will consider carefully in your treatment plan, choosing between a general or spinal. In some fracture cases, where the surgery is only minor, a local anaesthetic and mild sedation may be used.

Your surgery option is chosen based on the complexity and area of the hip that is broken.

For intracapsular fractures, surgery is performed to fix the cartilage on the ball that has been damaged whether that be through injury or displacement, and can sometimes include the acetabulum (socket) as it may be broken as well. These fractures can be repaired using individual screws (percutaneous pinning) or alternatively using a single larger screw that slides within the barrel of a plate. This will allow the fracture to be stabilised, however occasionally a secondary screw will be required to increase the stability.

For intertrochanteric fractures the procedure can involve a compression hip screw or intramedullary nail, which allow for impaction at fracture site. A compression screw is fixed to the outside of the bone and a larger secondary screw is then placed through the plate into the neck and head of the hip. Alternatively, an intramedullary nail is placed directly into the marrow canal of the bone and then a lag screw is then placed through the nail upwards and into the head and neck of the hip.

There are no studies to show that one method is more successful than the other, the surgical option will be based case by case on the severity of the fracture.

In the case of a subtrochanteric fracture, a long intramedullary nail is placed directly into the marrow canal of the bone with a large lag screw or screws that will be fixed at the neck and head of the femur, dependant on whether the bone has remained intact. A locking plate may be used for more complex and difficult fractures.

Benefits

  • The ability to return to regular activities
  • Regain mobility

Risks

As with any major surgery there are some risks involved. Potential risks include:

  • Loss of blood supply to femur causing part of the bone to die
  • Nerves or blood vessels can be damaged
  • Components of the hip bone may not be in the correct position or join together
  • You could experience blood clots in the legs or lungs
  • Post-surgery you may have some mental confusion

FAQs

Post-surgery what pain should I expect to experience?
Your doctor will prescribe short-term pain relief for any normal pain experienced. The day after surgery your physiotherapist will encourage you to get out of bed and will assist accordingly. Post-surgery you will be reassessed by Dr Rodda and he will decide how much weight you can bear.

How long will my recovery take?
Full recovery for a hip fracture can take up to three months for you regain your strength and the ability to walk. It is imperative that you follow your Doctor’s recommendations to ensure your recovery proceeds as planned. You may be prescribed blood thinners to reduce the chance of developing blood clots or recommended to use elastic stockings to aid the healing. You will be required to attend follow up appointments so that Dr Rodda can check your wound, remove sutures (if necessary), take revision X-rays and prescribe physical therapy exercise.

Are there any complications that can occur post-surgery?
You need to be aware of the heightened risks you may encounter after your surgery. If you’re sitting for a long time you may suffer pressure sores, you can develop a urinary tract infection and it’s possible you may get blood clots in your legs and lungs. Post-surgery you may experience a loss of muscle mass, increasing your chance of falls or injury. By following the advice given to you by your medical professionals and you can lower your chances of these risks happening.