Hip Fractures

Dr Rodda has a special interest in primary (Anterior Minimally Invasive Surgery), hip replacement, complex revision hip replacement surgery and hip fracture management. Dr Rodda’s knowledge, experience and attention to detail and the time he invests with each patient during treatment and post-surgery, are the reasons many Sunshine Coast patients select him as their surgeon of choice.

Total Hip Replacement

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 quarter of the femur. The type of surgery used to treat this depends on which bones and soft tissue is 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 (one of the major muscles of the hip). The blood supply to the fractured pieces tends to be better
  • Subtrochanteric – This occurs further down the bone 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 in 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.

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 you will be evaluated for surgery based on your overall health.  In very rare instances, surgery is not recommended and your comfort and the level of pain must be weighed against the risks of anaesthesia and surgery.  This may be the case if you are too ill or are already immobile.  In this case, Dr Rodda will closely monitor your injury with periodic X-rays and supervision.

Once you are approved for surgery, it is better to perform the operation fairly quickly to achieve the best results however we do also first complete cardiac and other diagnostic tests to ensure your safety and overall wellbeing.

There are two options for anaesthesia – general or spinal although in some cases where the surgery is only minor, a local anaesthetic with mild sedation is used instead.  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. If it is an Intracapsular Fracture, the procedure is intended to fix the cartilage on the ball that has been injured or displaced and sometimes the socket (acetabulum) which is often also broken. Injuries can be approached from either the front or back of the hip or sometimes both in order to clearly see and fix the injured bone. The fracture may be fixed with individual screws (percutaneous pinning) or a single larger screw that slides within the barrel of a plate. This allows the fracture to become more stable although occasionally a secondary screw may be added for increased stability.

For an Intertrochanteric Fracture the procedures of choice are a compression hip screw or intramedullary nail, which also allow for impaction at the fracture site.  A compression screw is fixed to the outer side of the bone with screws with a large secondary (lag) screw placed through the plate into the neck and head of the hip.  An intrameduallary nail is placed directly into the marrow canal of the bone with a lag screw then placed through the nail and up into the neck and head of the hip.

There are no studies to show that one method is superior to the other. Dr Rodda bases his decision on each individual case.
If you have suffered a Subtrochanteric Fracture your injury will be managed with a long intramedullary nail with a large lag screw or screws that capture the neck and head of the femur, if it has remained intact.

A locking plate may be used for more difficult to treat fractures.

Benefits, Risks, and FAQs

Since most fractures require surgery to be able to return you to mobility and can lead to other complications if not treated, it is recommended that most patients choose to proceed unless they are physically unable to do so.

Risks

As with all procedures there are factors you should be aware of:

  • Loss of blood supply to the femur during surgery can cause part of the bone to die
  • Injury can occur to nerves or blood vessels
  • Part of the hip bone may not join together at all or in the correct position
  • You can experience blood clots in the legs or lungs
  • Increased mental confusion post-surgery.

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 Dr Rodda 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 Dr Rodda’s 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 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 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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