The hip joint is the joint at the beginning of the leg (lower limb). It is the largest joint of the body and forms a very important for upright position of the human body and locomotion (all movements). It the articulation between the thigh bone (Femur) and pelvic bone (Acetabulum). It is a ball and socket joint where in the ball is the proximal end of the thigh bone and the socket is formed by the pelvic bone. Technically Hip fractures include fractures of bones of both sides of the articulation, but for all practical common purposes the discussion shall be limited to fractures involving the proximal end of the thigh bone. Also we shall limit information to Hip fractures in adults.
The proximal thigh bone can fracture inside the covering of the Hip joint – commonly referred to as Fracture Neck of Femur or it can fracture in the area just outside the covering of the Hip joint – commonly referred to as Trochanteric and Peri Trochanteric fractures.
The common cause in young and middle aged patients is severe trauma either due to falls with great force or fall from high altitudes or involvement in motor vehicular accidents.
In the elderly patient these fractures can be caused by trivial falls in the bathrooms or at home and even while walking on level surfaces. More common in females. In the male population it is commonly associated with intake of drugs that weaken the bone and chronic diseases like Parkinsons’, Diabetes and Kidney (renal) disorders.
In diseased conditions like cancer minor jerks in sitting position even while the braking force while driving can lead to hip fractures.
It is usually the first presentation of Osteoporosis (weak bones), also known as silent killer. More common in females.
There is pain in the hip joint area – often severe, inability to stand, bear normal body weight on the limb and inability to walk. There is pain on any and all movements of the hip. In the bed the limb attains an abnormal position and looks shortened due to bend at the hip fracture area. It is important for the patient to share data about illnesses specially those that weaken the bone.
To a trained orthopaedic surgeon the position of the limb and associated severe pain is sufficient to make a diagnosis. Plain X rays are done to assess the fracture. It is necessary to determine the type of fracture – Fracture Neck of Femur or Trochanteric/ Peri trochanteric fracture as the method of treatment differs in each type.
In the presence of other medical conditions scans – CT scan or MRI scan may be done as deemed necessary by the treating orthopaedic surgeon. Blood investigations are done and special tests maybe done to assess the other co morbid conditions. If the fracture is secondary to cancer – tests to assess the disease would also need to be done and shall include PET – CT scan and/ or Bone scan.
It is important to discuss with your orthopaedic surgeon about the optimum investigations for treatment of the patient.
In the adult patient the usual treatment offered is surgery in the form of fixation of fracture by means of screw plate construct or rod screw construct for Trochanteric/ Peri trochanteric fractures. In cases of Fractures of the Femur Neck the surgery would involve the use of screws, or plate screw construct or replacement of the Hip Joint. Surgery helps in proper alignment of the Hip joint thereby healing the fracture in optimum position and avoids deformity. The large muscles around the hip and their huge deforming forces on the fractured ends are neutralized by surgery and proper fixation. Advantages of operative treatment include stable and rigid stabilization which takes care of pain immediately. This facilitates nursing care in bed, early return to activities of daily living and early ambulation, mobilization and rehabilitation. Thereby the complications of being in bed for prolonged position like pressure sores, lung infections, deep vein thrombosis, etc., are avoided.
Hip fractures may need to treated without surgery in patients who are medically unfit to undergo surgery. However, it is worthwhile to understand the risk of surgery from your orthopaedic surgeon and still take the calculated risk for surgery as the benefits of surgery out weigh the complications of treating hip fractures non operatively. Possible complications of not operating hip fractures include bed sores, lung infections, deep vein thrombosis (clotting), mal union, non union and instability had hip joint. In the event the patient does survive the period of non operative healing the resultant sequelae of non union, mal union and shortening lead to compromised mobility and ambulation and in the long run leads to problems with lower back and spine.
It would be very important to discuss with your orthopaedic surgeon in detail about the possible outcomes of treating hip fractures in your patient and also the best possible mode of fixing the fracture for your patient.
Since hip joint is the largest joint in the body surrounded and operated by heavy muscles you shall be instructed and encouraged to start rehabilitation and exercise programme as early as with in 24 hours after surgery. You shall be instructed to carry out set of exercises specific to your surgery and you shall experience some discomfort and pain during the same. It is important for you to carry out the same, however if the pain and discomfort is beyond your level of tolerance then kindly discuss to alter your rehabilitation programme suitably. Should you refrain from doing physiotherapy then to get the heavy muscles around the hip moving shall become a very difficult task.
When you sustain fracture due to aging and Osteoporosis kindly discuss and follow the treatment for Osteoporosis diligently to avoid more fractures in the future.