Hip Fracture Repair

What is Hip Fracture Surgery?

Surgical correction of a hip fracture is known as hip fracture surgery.

Hip fractures involve a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.

Anatomy

The hip joint is a “ball and socket” joint.  The “ball” is the head of the femur or thigh bone, and the “socket” is the cup-shaped acetabulum. The hip joint enables the upper leg to bend and rotate at the pelvis. The joint surface is covered by a smooth articular surface that allows pain-free movement in the joint.

Causes of Hip Fractures

Hip fractures are most frequently caused after minor trauma in elderly patients with weak bones, and by a high-energy trauma or serious injuries in younger people. Long term use of certain medicines, such as bisphosphonates to treat osteoporosis (a disease causing weak bones) and other bone diseases, increases the risk of hip fractures.

Signs and Symptoms of Hip Fractures

Signs and symptoms of hip fractures include:

  • Pain in the groin or outer upper thigh
  • Swelling and tenderness
  • Discomfort while rotating the hip
  • Shortening of the injured leg 
  • Outward or inward turning of the foot and knee of the injured leg

Diagnosis of Hip Fractures

Your doctor is able to diagnose a hip fracture based on your symptoms, abnormal posture of your leg and hip, and a thorough physical examination. Your doctor may also order imaging tests, such as X-rays, MRI scan, or bone scan to confirm and view the hip fracture.

Preoperative Assessment

A preoperative assessment will be made before surgery to check your overall health to make sure you are ready for the surgery. You will be asked about any medications that you are taking and the need to stop if necessary. You will have an anesthetic assessment to decide on what type of anesthesia will be used during surgery. You will be given antibiotics to reduce the risk of wound infection post surgery. An anticoagulant such as heparin may be given since the surgery carries the risk of a blood clot. Blood tests, urine samples, chest X-rays, electrocardiograms will be checked to look for any irregularities.

Surgical Treatment of Hip Fractures

Surgery is employed when a conservative approach such as medications, injections, and physiotherapy fail to provide satisfactory results.

Hip fracture surgery is performed under anesthesia either arthroscopically or through open surgery. Your surgeon will decide which approach is the best for your condition.

In general, an incision is made at the top of your thigh to expose the bones of the hip joint. The fractured or damaged joint is replaced with a prosthesis. The leg is moved to check for a satisfactory range of motion once the prosthesis is placed. The surgical incision is then closed with sutures and dressings to complete the operation.

Different surgical procedures are used for the treatment of hip fractures, and the type of surgery normally depends upon the severity and location of the fracture.

  • Total Hip Replacement: This is an operation to replace both the natural socket in the hip and femoral head with prostheses. The upper femur and the socket in your pelvic bone are replaced with a prosthetic implant. 
  • Partial Hip Replacement: This is an operation to replace the damaged femoral head with a prosthesis. The traumatically fractured or damaged ball-like head of the thigh bone (the femoral head) is replaced with a prosthetic implant.
  • Internal Fixation: This is an operation to hold the bone in place while it heals with screws, pins, rods, or plates. Your fracture will be corrected by placing a sliding hip screw into the head of the thighbone (femur), secured to the top of the thigh bone to hold the fracture together.

Postoperative Care Instructions

Instructions for postoperative care include:

  • Use of assistive devices such as splints and crutches for walking
  • Keep your leg elevated to decrease swelling
  • Rest the hip as much as possible 
  • Medications to control pain and swelling
  • Limited weight-bearing activities
  • Follow a balanced, varied diet
  • Physiotherapy to improve flexibility, range of motion, and strengthen muscles
  • Adhere to follow-up appointments

What are the Risks Associated with Hip Fracture Surgery?

As with any surgery, some of the potential risks associated with hip fracture surgery include:

  • Improper or non-union of bone
  • Infection and wound complications
  • Damage to nerves and blood vessels
  • Leg-length discrepancy
  • Fracture
  • Bleeding
  • Deep vein thrombosis (blood clot)
  • Bedsores due to lack of movement post surgery
  • Muscle atrophy
  • Deterioration of mental health in old patients
  • Avascular necrosis

What are the Benefits of Hip Fracture Surgery?

Some of the benefits associated with successful hip surgery include:

  • Reduced pain
  • Decreased stiffness
  • Improved mobility, strength, and coordination
  • Ability to maintain an active lifestyle