Operative Treatment of Hip Fractures
What are Hip Fractures?
A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thighbone 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 thighbone. Hip fractures usually occur due to a break in the femoral neck between the greater and lesser trochanters or below the lesser trochanter.
Causes of Hip Fractures
Hip fractures are frequently caused by minor trauma in elderly patients with weak bones, or by high-energy trauma in young 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 fracture 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 Subtrochanteric Hip Fractures
Your doctor may order an X-ray to diagnose a hip fracture. Other imaging tests, such as magnetic resonance imaging (MRI) may also be performed to detect the fracture.
Treatment for Hip Fractures
A hip fracture can be corrected and aligned with non-operative and operative methods. Traction may be an option to treat your condition if you are not fit for surgery. Skeletal traction may be applied under local anesthesia, where screws, pins and wires are inserted into the femur, and a pulley system is set up at the end of the bed to bear heavy weights. The heavy weights help in correcting the misaligned bones until the injury heals.
Surgery for Hip Fractures
Surgery is usually the main treatment for hip fractures. Surgical options include external fixation, intramedullary fixation or by using plates and screws.
- External fixation:Temporary fixation used for severe open fractures. Pins are inserted into each of the fractured fragment and supported with tubes close to the bone. The tubes are interconnected together with short tubes to provide more stiffness for the frame.
- Intramedullary fixation:involves managing the fracture with a long intramedullary nail which is fixed with a large screw. Additional screws known as interlocking screws are inserted at the lower end of the nail to prevent rotation of bones around the nail.
- Plates and screws: You surgeon mayuse a plate with screws attached instead of a nail in certain cases. Screws will be fixed into the bone from the outer side of the femur. A large screw will be inserted through the femoral neck and head, and other screws will be inserted across the length of the plate to hold the fracture together.
Risks and Complications Associated with Hip Fracture Surgery
As with any surgical procedure, surgery for a sub trochanteric fracture involves certain risks and complications including:
- Non-union of fracture with pain
- Limp or limited hip rotation due to malunion
- Nail or screw fixation failure
- Wound infection