Hip Fractures - Symptoms, Diagnosis, Treatment and Precautions
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Treating Hip Fractures

Dr.Surya Rao Poodipeddi profile Authored by Dr.Surya Rao Poodipeddi on 2 Jun 2014 - 17:17.

Fracture Neck of the Femur:

Fracture neck of the femur is the commonest fractures encountered especially in the elderly group of persons. About 90 percent of the fractures occurring in the elderly are the hip fractures and most of these fractures are due to osteoporosis and the increased tendency to fall among this age group. It is estimated that roughly one in three women and one in six men who reach 90 will fracture a hip during their lifetime.

Most hip fractures occur below the spherical head of the femur at the level of the femoral neck called sub-capital hip fracture or through the trochanters when it is called as intertrochanteric hip fracture.

Fractures at the femoral neck are particularly very challenging because the fracture often disrupts the blood supply to the femoral head which forms the hip joint. With poor or inadequate blood supply the femoral head, it collapses. Inter trochanteric fractures end up with large broken bone surfaces that are responsible for internal bleeding unless attended to immediately.

Symptoms and Diagnosis:

As soon as one falls, they cannot move their leg nor can they stand up. The doctor examining the person finds that the affected leg appears shorter than the other leg and is turned outwards due to gravity and unopposed pull of muscles. It may be noticed that a swelling and a bruise occur because of the leaking of blood from the fractured portion.

A simple through and through fracture can be easily identified through an X-ray if taken well. However, a hairline fracture cannot be easily identified and may need MRI (Magnetic Resonance Imaging) for a confirmative diagnosis.

Treatment:

Most people with a hip fracture are treated with surgery. The type of surgery depends on the type and site of fracture. As already described there are two types of fracture in the hip namely the sub capital hip fracture and the intertrochanteric hip fracture. If the fracture is not too severe, metal pins are inserted surgically to keep the broken pieces in proper alignment and immobilized. This type of surgery with pins allows the patient to have his own hip joint.

However, in cases where the fractured pieces cannot be fixed with pins, the alternative procedure called Prosthesis is preferred which involves removing the fractured femoral head and neck and inserting a stainless steel femoral head to fit into the cleaned and cleared acetabular cavity. This cavity is later augmented by replacing the ligaments and the muscles in their place. The metallic implants have a polished spherical surface to match with the joint socket and a strong stem to fit with in the central marrow canal of the thigh bone.

Treatment of Inter-trochanteric Fractures of the hip joint involves use of an implant such as a sliding compression screw and a side plate. The implants securely hold the fractured bone fragments in their proper position while giving immobilization and time for the fracture to heal. The fixation with an implant is considered strong enough to permit the person to bear weight as tolerated It takes roughly two months for the bone fragments for complete healing and most of the people continue to improve in terms of comfort, strength and ability to walk over a period of 6 months.

If the topmost part of the femoral head is badly damaged it has to be replaced with an artificial part called the prosthesis. This procedure of replacing the head is called partial hip replacement. Very rarely, the socket into which the femoral head fits may also need replacement due to severe damage to the cavity as well, and this procedure of replacing both the damaged cavity and the femoral head is known as total hip replacement. The procedure uses a metal shell lined with durable plastic.

After joint replacement surgery, whether partial or total, the person usually begins walking with crutches or a walker immediately and switches to a cane with suitable adjustment of the exact height needed in about 6 weeks' time. However, artificial joints do not last forever. The concerned person, especially if heavy and active, may need to go in for a second operation roughly 10 to 20 years later if everything else goes well after the surgery and the surgery itself has been handled by an experienced surgeon. Joint replacement is often advantageous to older people as they can walk almost immediately after the operation.

The unique benefit from hip replacement surgery is the fact that the patient can be mobile within two days after surgery unlike in cases with conventional treatment that may render the patient bed ridden. This can lead to bed sores and embolic phenomenon and inter-current infections due to bedsores.

It is very important for the caretakers of the injured to be aware of the basic principles involved while rendering help to the victim. In other words one should be aware of how to handle such a victim until medical help is available.

Attention After the Fall: The first and foremost need is to comfort the patient with reassuring words and she should be told not to try moving the affected limb or else a simple fracture may become complicated.

The next step is to gently handle the affected limb in such way that it is least painful. Artificial splints like walking sticks or closed umbrellas can be utilized as temporary splints and bound by bandages or cloth pieces.

The best first aid in such cases is through the use of a Thomas Splint.  A suitable size between small, medium and large is chosen, a roller bandage is wound on the base of the splint for the leg to rest, the ring of the splint is pushed in up to the level of the groin taking care to support the limb, and a traction applied to the foot end of the splint itself as the limb stations on the bed of the bandaged area. This maneuver will keep the patient in comfort during transit to the hospital besides assuring immobilization during transport.

The golden rule is avoid handling a patient if you are now aware of these basics. Let the patient lie down wherever he has fallen in the same position till medical help arrives.

*Disclaimer: This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.