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Hip Fracture

What is a Hip Fracture

$fractures$ A fracture is simply another word for a break. A break to the hip occurs in the upper part of the femur in one of three places.

The sub-trochanteric region
The inter-trochanteric area
The femoral neck

Fractures may be

displaced - where the bones have moved out of their normal position
non-displaced - where the bones have remained in position
impacted - where the femoral head is pushed into the femoral neck.

The X-ray below shows a displaced, sub-capital fracutre.

$displace, sub-capital fracture$

Who Is Affected?

Although such fractures can affect people of all ages the majority are found in elderly people following a fall.

80% of people who sustain a hip fracture are women and the average age of fracture is 80 years.

How Many People Are Affected?

In the UK about 75,000 fractured hips are treat each year but, with an aging population this figure is expected to double by 2050.

Symptoms

The major symptom is severe pain in the hip area and possibly the upper leg. The patient will not being able to weight bear or walk or stand. The leg may be turned outwards and appear shorter than the healthy one.

Diagnosis

An X-ray will be taken to determine if the hip is broken or not. However not all hip fractures show up on X-rays and some will only show up many hours after the accident has happened. A radioisotope bone scan or an MRI may be able to detect the problem straight away.

X-rays may be repeated after 24 hours.

Fractured Hip Treatment

A hip fracture is a very serious life threatening condition with a high mortality rate.

Most people who have fractured their hip will require surgery.

Inter-trochanteric and sub-throchanteric fractures are normally fixed with rods, plates and screws (see above).

Fractures of the femoral neck are more complex.

Firstly because the blood supply to the region is limited and any disruption may lead to avascular necrosis where the lack of blood leads to the death of the bone and secondly because there is less cancellous bone present which means that the bone is much less likely to be able to mend.

The surgeon will need to decide whether to attempt to mend the fracture or to replace the hip. Mending the fracture will involve putting the pieces of bone back together and holding them in place with screws. If this works then you have achieved the best outcome. However the procedure will require a long period on crutches and there is still a chance that avascular necrosis will develop or that the bone will simply not heal. For these reasons a hip replacement may be the treatment of choice especially if there are signs of arthritis already present.