HIP FRACTURE SURGERY & MANAGEMENT
HIP FRACTURE OVERVIEW
The hip is a ball and socket joint. It allows the upper leg to bend and rotate at the pelvis. A hip fracture is a break which occurs in the upper part of the femur. The type of surgery used to treat this depends on which bones and soft tissue are affected and the level of the fracture. (An injury to the socket is not considered a hip fracture and management of fractures of this area is a completely different consideration.)
Most hip fractures occur from a fall or direct blow to the side of the hip. There are generally three different types:
- Intracapsular – occurs at the level of the neck and the head of the femur and is generally within the capsule. The capsule is the soft tissue envelope that contains the lubricating and nourishing fluid of the hip joint. Sometimes this 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. The blood supply to the fractured pieces tends to be better.
- Subtrochanteric – This occurs below the level of the lesser trochanter and may be broken into several pieces.
In more complicated cases, the amount of breakage can involve more than one of these zones.
Some medical conditions including osteoporosis, cancer or stress injuries can weaken the bone and make the hip more susceptible to breaking. In some cases, patients can break their hip merely by twisting into an awkward position.
Some medical conditions including osteoporosis, cancer or stress injuries can weaken the bone and make the hip more susceptible to breaking. In some cases, patients can break their hip merely by twisting into an awkward position.
A hip fracture causes pain over the outer upper thigh or in the groin. There is significant discomfort especially during any attempt to flex or rotate the hip. There can also be an aching in the groin or thigh period prior to the break. If the bone is completely broken, the injured leg may appear shorter and the patient will often hold the injured leg and foot facing outward.
HIP FRACTURE PROCESS
Diagnosis is generally made via X-ray of the hip and femur. Sometimes after a fall, an incomplete fracture can be missed on a regular X-ray. In that case, an MRI (magnetic resonance imaging) may be required. If you are unable to have an MRI due to a medical condition, a CT scan (Computed Tomography) will be performed instead. Although not as sensitive as an MRI it can still show up hidden hip fractures.
Once the diagnosis is made, your surgeon will discuss with you the best method of fixing your type of fracture. Evidence shows that it is better to perform the operation on a fractured hip quickly to achieve the best outcomes, however there will be a full workup of your health to ensure your safety and overall wellbeing.
There are many options for anaesthesia – including a general anaesthetic, or sedation with a spinal anaesthesia amongst other combinations. All patients receive antibiotics during and post-surgery.
Dr Rodda’s decision on the best method of surgery will depend on the area of the hip that is broken. Your surgeon will choose the optimal operation for you based on the type of fracture you have.
BENEFITS & RISKS
Since most fractures require surgery to be able to return to mobility, and there are significant other complications that can occur if the fracture is not treated due to being bed bound such as pneumonia, urinary tract infections and pressure sores amongst other issues, it is a consensus recommendation that most patients proceed unless they are significantly unwell or unable to do so.
Risks
As with all procedures there are factors you should be aware of:
- The fracture may fail to heal and require subsequent surgery
- Injuries can occur to nerves or blood vessels
- You may require a blood transfusion due to bleeding
- You can experience blood clots in the legs or lungs
- Increased mental confusion post-surgery
- Each anaesthetic carries its own risk
FAQs
What should I expect post-surgery?
Pain is a natural part of the healing process however you will be prescribed medication to help provide short-term pain relief. You will be encouraged to get out of bed on the day following surgery with the assistance of a physiotherapist. The amount of weight you can place on the injured area will be determined by your surgeon depending on your procedure.
How long will my recovery take?
Full recovery can take up to 3 months as you regain your strength and the ability to walk. It is important that you follow your surgeons instructions to ensure your recovery proceeds as planned. You may be placed on blood thinners to reduce the chance of developing blood clots or need to use elastic stockings. You will be required to attend follow up appointments so that Dr Rodda, Dr Connon or
Dr Murray can check your wound, remove sutures if necessary, take X-rays and prescribe physical therapy.
Are there any post-surgery complications?
If you are sitting for longer periods than usual you can suffer from chest infections, pressure sores or ulcers, develop a urinary tract infection or blood clots in your legs or lungs. There may also be further loss of muscle mass, increasing your risk of falls and injury. By following the recommendations of your physiotherapist and doctor, you will minimise the risk of these happening.
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Sunshine Coast University Private Hospital
Suite 12, 3 Doherty Street, Birtinya, QLD, 4575
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