Introduction
The fractures in the femoral head and neck are hip fractures. It occurs mostly in the case of elderly patients whose bones have become weakened by osteoporosis. It typically results from a high-energy event, such as a fall from a ladder or a vehicle collision. Hip fractures can be very painful. For this reason, prompt surgical treatment is recommended.
What Are the Types of Hip Fractures?
A single or multiple breaks can happen in a bone. A hip fracture is thus classified by the specific area of the break and the type of break in the bone. The types of hip fractures are classified below:
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Femoral Neck Fracture: The femoral neck is located about one to two inches from the hip joint and is common among older adults with osteoporosis. Such fractures may cut off the blood supply to the head of the femur.
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Intertrochanteric Hip Fracture: An intertrochanteric hip fracture occurs about three to four inches from the hip joint and does not usually interrupt the blood supply of the bone, thus making repair easier.
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Stress Fracture: A stress fracture of the hip is harder to diagnose. A hairline crack in the thigh bone may not involve the entire bone. It is usually caused by overuse and repetitive motion. A stress fracture can mimic the symptoms of tendonitis.
What Causes a Hip Fracture?
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A hip fracture among the elderly is most commonly caused by falls. It may occur spontaneously. In younger patients, a hip fracture is generally the result of accidents such as falls from a great height or severe trauma caused by vehicular incidents.
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In older people, generally due to osteoporosis, the loss of calcium may lead to thinning and weakening of bones. As a result, they are more likely to break in the event of a fall, even while walking on a level surface, often at home.
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Women lose 30 to 50 percent of bone density with age. However, bone loss speeds up dramatically after menopause because less estrogen maintains bone density and strength.
What Are The Risk Factors For Hip Fractures?
The risk for a hip fracture is considerably raised with osteoporosis and older age. Other risk factors for hip fractures are as follows;
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Excessive alcohol consumption.
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Lack of physical activity.
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Low body weight.
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Poor nutrition with low calcium and vitamin D intake.
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Female predilection.
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Tall stature results in increased stress in stress-bearing areas.
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Vision problems lead to being more prone to falls or accidents.
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Dementia and conditions associated with mental retardation.
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Physical problems.
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Certain medicines may cause bone loss.
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Living in an assisted-care facility.
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Increased risk for falls stems from weakness, disability, or unsteady gait.
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Other risks, depending on specific health conditions, may also occur.
What Are The Signs and Symptoms of a Hip Fracture?
The common symptoms of a hip fracture include the following;
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Hip pain or pain that is felt in the knee.
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Inability to stand or walk or bear weight on the affected leg.
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Limited range of motion.
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Stiffness and tenderness in the hip and surrounding area.
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Bruising.
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Swelling.
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The foot is turned at an odd angle, making the leg look shorter.
How is Hip Fracture Diagnosed?
A good medical history and physical exam, along with diagnostic procedures for hip fracture, include the following:
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Clinical Evaluation: The healthcare provider may physically examine the patient and check the weight of the affected leg. They may also check the signs of deformity. They may also ask the patient about any previous injuries.
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X-rays: X-ray scans reveal the type of fracture, whether it is a hairline crack or a proper break, and if the fracture has caused the displacement of the bones.
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Magnetic Resonance Imaging (MRI):MRI scans may reveal any damage to the surrounding soft tissues.
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Computed Tomography (CT) Scan: CT scans show the three-dimensional location of the fracture.
How Is Hip Fracture Treated?
The hip fractures can be managed by a multidisciplinary approach, including orthopedics, nurses, and physical therapists. The treatment strategies for managing hip fractures are as follows:
Emergency Treatment: The first step is to stabilize the injured hip. Patients are advised to avoid weight-bearing on the affected leg.
Surgical Intervention: Surgery is the final approach to manage hip fractures that involve the femoral neck. The surgical treatment is to stabilize the fracture. The common surgical procedures are as follows:
1. Hip Pinning: The surgical procedure to stabilize hip fractures is hip pinning. It is a type of internal fixation, which involves the placement of pins and screws to stabilize the hip fracture. However, there are risks and complications after the hip pinning procedure. The complications after hip pinning are as follows:
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Infections at surgical site.
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Nonunion or delayed union.
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Improper alignment of fractured bone.
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Problems related to implants, such as loosening of screws and migration of screws.
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Nerve and blood vessel injury.
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Joint stiffness.
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Postoperative pain.
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Allergic reactions.
2. Hip Replacement: The procedure in which there is partial or total hip replacement. This may be recommended for older people.
3. Physical Therapy: The healthcare provider may advise the patient to exercise to improve mobility, strength, and function.
4. Pain Management: The doctor may advise oral and intravenous medications to alleviate pain and discomfort.
5. Nutritional Support: The doctor may advise the patient to take adequate nutrition for early healing and recovery.
What Are the Complications of Hip Fracture?
A hip fracture can cause complications such as blood clots in the veins, usually in the legs, or pulmonary embolism, which can be fatal.
Other complications can include:
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Muscle atrophy (wasting of muscle tissue).
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Postoperative infection.
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Nonunion or malunion.
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Mental deterioration post-surgery in older patients.
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Bedsores.
Femoral avascular necrosis is a complication that may happen depending on the type of fracture and the blood supply to the head of the thigh bone, which is more commonly seen in femoral neck fractures.
How Long Does Postoperative Recovery Take?
Usually, one to two weeks of in-hospital stay is necessary after a hip fracture, with the recovery period being lengthy and admission to a rehabilitation facility. In addition, it can result in a loss of independent movement, reduced quality of life, and depression, especially for older people.
What Are the Preventive Measures?
Preventive measures include consuming enough calcium daily, whether through diet or supplements. Menopausal women should regularly consider having a bone density test, measuring bone mineral content and thickness. The measurement can indicate decreased bone mass or more brittle bones prone to fracture easily. A bone density test for osteoporosis and the risk of fractures is the primary diagnostic measure. Regular weight-bearing exercises like walking, jogging, or hiking are advised to maintain bone integrity. In addition, exercise programs such as Tai Chi help promote strength and balance.
Other preventive measures may include:
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Medication to prevent bone loss.
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A vitamin D and calcium-rich diet.
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Reduce alcohol consumption.
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Removing objects like loose electrical cords near or on the stairs and floors prevents tripping and falling.
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Use slip-resistant rugs next to the bathtub.
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Installing grab bars in the tub or showers.
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Positioning of night lights from the bedroom to the bathroom.
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Use rug pads or non-skid backing to keep rugs in place to prevent slipping and falling.
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Using steady furniture.
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Using step ladders to stand on.
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Ophthalmologist consultation every year to have vision checked and vision loss treated.
Conclusion
Hip fractures can result in a loss of independence, reduced quality of life, and depression, especially in older people. In addition, recovery usually takes a relatively long time, especially with greater age. Therefore, postoperative care and physical therapy are paramount in such cases.
