A hip fracture is a crack, a break or fracture in the long thigh bone, near the hip joint. This kind of fracture is very commonly caused by osteoporosis, and is broken down into four different fracture patterns. These fractures can involve the femoral head, the femoral neck, subcapital or intra-capsular fractures, or subtrochanteric fractures involving the shaft of the femur below the lesser trochanter.
Hip fractures are either a fragility-type fracture, where it happens in patients with osteoporosis-weakened bones with mild trauma; or in healthy individuals caused by high trauma incidents such as motor vehicle accidents or falling from a height. Unfortunately, there is a high mortality rate (between 20-35%) with a hip fracture.
Signs and symptoms
Most of the patients whom we see are usually elderly, who had a fall (low fall or high trauma ones), present with pain and not able to weight bear on the affected leg or hip because of the pain. When we examine the patient, the affected hip joint is often in external rotation and flexed higher than the other leg.
For patients who sustains a hip fracture after a fall, most of the time they are likely to have sustained a pathological fracture, of which the most common causes are:
X-Rays of the hip fracture is usually straight forward, but in some cases, can't be seen until much later (maybe because the fracture is too small to be noticed) or seen via CT scan or MRI.
Most of the time, surgery is treated via orthopedic surgical intervention, where the surgeon will implant an orthoses to support the fracture. This surgery is often visited by a lot of pain, and the elderly who had underwent this kind of surgery usually has decreased mobility. The thing is, post-operation immobilization can be more of a health risk than the surgery itself, so the doctors would often bring in the physiotherapiststo provide exercise therapy to train and increase the patient's mobility.
But if the risks are deemed too high by the doctors or the patient, or if the patient/family refuses operation, then the focus will shift to conservative management, managing pain relief, and preventing worsening of the fracture. Sometimes the doctors will request for traction to correct the alignment of the broken bones, and order for aggressive chest physiotherapy to prevent and reduce the risks of chest infections such as pneumonia as well as nurses to prevent the possibility of bed sores and deep vein thrombosis from developing.
Doctors prefer to prescribe plate and/or screws for low-level fractures (Garden 1 and 2), but for the elder patient with a displaced fracture, surgeons prefer to prescribe a bipolar hemiarthoplasty, which replaces the broken bones with a metal implant. This allows immediate mobility, which has much benefits in terms of chest clarity, moving up and about in the wards, and easier to discharge to home.
Of course, like all disorders and diseases, there are risks of complication. Some of the common ones include - mal-union (healing in an angulated manner), non-union (bone healed without joining back), non-healing (bone doesn't heal), and insufficient blood supply because of blood interruption leading to avascular necrosis.
A hip fracture is very stressful, painful and dangerous to the elderly patients. The risks of mortality is very high, about 10% within the first week. If the problem is untreated, patient will be bedbound and highly susceptible to pneumonia (of which, may kill) or the development of urinary tract infections or bed sores, of which, all can lead to mortality.
Untreated fractures of the hip have very poor prognosis.
Our patients with hip fractures respond well to physiotherapy and exercise therapy post operatively. Those who develop chest issues are able to clear their chest with chest physiotherapy, as we slowly rehabilitate them to increase their strength and mobility, before discharge to their homes or their children's homes. Some even return back to their homes without the need for any carers.
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