Hip Fracture
Broken Hips In The Elderly

Osteoporosis of the hips

Hip Pain After Fall

80 percent of breaks occur in women.

Hip Fracture

Contents

What Is A Fracture Of The Hips?
Are All Fractures The Same?
What Are The Causes?
What Are The Symptoms?
What Should I Do If I Think I Have A Fracture?
How Is It Diagnosed?

How Is It Treated?
Rehabilitation After Surgery
Possible Complications
Prevention


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Osteoporosis Guide

What Is A Fracture Of The Hips?

It is another term for a broken hip. About 80 percent of all fractures happen to women and the average age of the patient is 80 years old. In 2006 there were 316,000 hospital admissions for hip fractures in America (75,000 in the UK), an increase of 7 percent on the previous year. Given the advancing age of our population researchers think this number could climb to half a million by 2040. 90 percent of all fractures are caused by falling, and most commonly falling sideways and landing on the hip (see osteoporosis statistics). Some medical conditions can weaken a person's bones making them more prone to fracture, this includes osteoporosis, previous injuries and cancer. In extreme cases simply standing on the leg and twisting awkwardly can break the hip.

Are All Fractures The Same?

No, hip fractures are generally split into two types:

Femoral Neck Fractures
This is when the ball of the ball and socket of the hip joint is fractured and separates from the femur bone. This is a serious injury and is associated with a high mortality rate in older people. The incidence rate of this type of fracture has been increasing since the 1960s and is expected to continue in line with our aging population.

Intertrochanteric Hip Fractures
Also called extracapsular fractures, this break occurs lower than a femoral neck fracture and as a result is easier to repair and does not usually require complete hip replacement surgery. 55 percent of hip fractures are intertrochanteric. A fracture can also be described as 'displaced' meaning the broken bone has moved out of its position. If it is 'non-displaced' even though the bone is broken, no fragments have moved out of position.

What Are The Causes?

Most incidences in older people are caused by a fall. Those diagnosed with osteoporosis will have brittle bones which makes them more vulnerable to breaks when they do fall. The reason why people fall can vary. Some might trip over a rug or a chair, or others may faint because of low blood pressure (hypotension). If an underlying medical condition caused the fall, the doctor will want to treat this as well. Fractures can occur in younger people but it is likely to be the result of an accident, such as a car crash.

What Are The Symptoms?

Most patients will complain of pain in the general hip area as they walk. However some may only aware of of a vague pain in their buttocks, thighs, knees, groin or back. The patient may still be able to shower and dress themselves, even walk around the house. One obvious sign is a limp and sometimes the affected leg looks shorter and turns outwards. Patients with Alzheimer's disease may forget they have fallen, so it is important for their carer's to be aware of the signs of a hip fracture. A delay in diagnosis can lead to a rapid decline in quality of life in the patient and increases the risk of morbidity.

Know the Signs: Symptoms of Osteoporosis

What Should I Do If I Think I Have A Fracture?

If you think you may have fractured your hip, call an ambulance or ask someone to drive you the hospital. While waiting for the ambulance try to sit still and stay warm. Cover yourself with a blanket. Avoid eating or drinking anything. When the ambulance arrives you may be given a pain killer and transported to the ambulance by stretcher.

How Is It Diagnosed?

If you have gone to a hospital you will be quickly assessed in the A&E department. You may be given more painkillers and asked a variety of questions including:

• How severe is the pain?
• Can you put weight on the side of your injured hip?
• Have you been diagnosed with any other medical condition such as osteoporosis?
• Have you had a bone density test before?
• What medications are you taking?
• Do you drink or smoke?
• Are you currently living independently?

Next you will be sent for a standard X-ray which will confirm if a fracture has occurred, and if so, in what part of the hip. If the doctor cannot see a fracture a CT scan or MRI scan may be ordered as they can offer more detail and can pick up small hairline fractures. The doctor will need to rule out other possible causes. For example a stress fracture can have the same symptoms as a hip fracture but pain is generally worse at night. Other possible causes includes osteoarthritis which can cause hip pain and limping that progressively worsens over time. Other diagnostic possibilities include:

Bone
Metastatic disease, vascular necrosis of the femoral head and primary neoplasm.

Joint
Inflammatory arthritis, crystalloid arthritis, septic arthritis and an acetabular tear.

Muscles and Tendons
Muscle strain, tendonitis, bursitis, pyriformis syndrome and myositis ossificans.

Spine
Lumbar disc problems, sciatica, coccygodynia and meralgia paresthetica.

Others
Hernia or pain referred (originating in) the knee, foot or ankle.

How Is It Treated?

Once a diagnosis has been confirmed, the patient will be referred to orthopedics for treatment. Most people will required surgery to fix the broken bone. The type of surgery will depend on which fracture has occurred. Non-surgical options such as traction are only considered where the risks of surgery are too high (for example is the patient is very elderly or has a serious illness).

Femoral Neck Fractures
There are 3 different options for repairing a femoral neck fracture. These are:

Internal Fixation
If the bone is still in place (aligned), metal screws will be inserted into the bone to hold it together while it heals naturally. Sometimes bone nails (gamma nails) are also used for additional security.

Hemiarthroplasty
This is where part of the femur is removed and replaced by a prosthesis. If the bones are not aligned or damaged beyond repair an artificial metal replacement is inserted.

Total Hip Replacement
This procedure (arthroplasty) involves replacing the upper femur bone and the socket of the pelvic bone with a prosthesis. This operation is commonly used in patients with hip arthritis as well as knee arthritis.

Intertrochanteric Fractures
More than one piece of bone is usually fractured with this condition. During surgery the patient will lie on a special table that allows the surgeon to see by X-ray how well the hip bones are lining up. Under general anesthesia, a surgical cut is made in the thigh. The fracture is stabilized using a lag screw and plate which keeps the 2 fragments binded in position. The fracture normally takes 3 to 6 months to heal. The screws are left in place in most elderly patients as the risk of a second surgery are considered too great.

Rehabilitation After Surgery

Within 24 hours of surgery the patient will begin working with a physiotherapist. They will be helped to walk with the aid of a walker and encouraged to try range of motion and strengthening exercises. Hospital stays usually last one week, depending on whether or not the patient has an able carer to go home to. Some hospitals even have specialized geriatric-orthopedic rehabilitation wards especially for elderly people who have sustained injuries. At home an occupational therapist may visit the patient to offer advice on everyday useful techniques, such as how to dress, bath and cook while recovering from the injury. They may also recommend arthritis equipment or aids, which will be useful under the circumstances.

Possible Complications After Surgery

Infection: Pneumonia or infections at the site of wound are possible. This is treated with antibiotics.
Deep Vein Thrombosis (DVT): A clot may occur in the leg which can break and end up in the lungs where it could cause pulmonary embolism (PE). The patient will normally be prescribed blood thinners to prevent this.
Fracture Non-Union: Where the fracture does not heal or fuse back together.
Avascular Necrosis: Where blood supply to the thigh bone is damaged and blood flow is restricted. This can cause the tissue to die.

Prognosis

If a patient delays diagnosis and treatment their risk of morbidity is increased significantly. Even then, 2 in 10 patients die within a year of their fracture. Furthermore, nearly 25 percent of patients who lived independently before their fall will need to stay in a nursing home for a year after injury. For this reason, hip fractures where possible need to be avoided in old age.

Fact: The average cost of a hip fracture over a lifetime is $81,000.

Prevention

The best way to prevent a hip fracture is to reduce your chance of falling. To do so:

1. Take care of your bones, See: osteoporosis prevention.
2. Exercise regularly to improve leg strength and sense of balance. Tai chi is often recommended by doctors. See: Alternative treatment for osteoporosis.
3. Assess your home for any items that could make you trip. Remove rugs, clear excess furniture and keep electrical cords pinned against the wall.
4. Have your eyes checked regularly.
5. If you are taking medications for another condition which cause you feel dizzy or weak, ask your doctor for an alternative prescription.
6. Consider using a walker for stabilization.
7. Hip protectors (a special pad to wear around the hips) were recommended in the past to reduce the chance of a break if you did fall. There is increasing evidence now however that they are not particularly effective.

Furthermore maintaining a healthy body weight will help reduce your osteoporosis risk factors (as well as other diseases such as arthritis and coronary heart disease). Obesity also increases the chance of complications after surgery.

  Related Articles on Hip Fracture

Osteoporosis diagnosis: Diagnostic tests and scans.
Losing height with age: What is considered normal shrinking?
Osteopenia: The stage before osteoporosis.

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