Most hip fractures occur from a fall or from a direct blow to the side of the hip. Medical conditions such as cancer, stress injuries, or osteoporosis can all weaken the bones and make the hip more susceptible to breaks. It is possible for the hip to break from the patient standing on the leg and twisting sideways.
Types of Fractures and Treatment
In general, there are three different types of hip fractures. The type of fracture depends on what area of the upper femur is involved. These include intracapsular fractures, intertrochanteric fractures, and subtrochanteric fractures.
- Intracapsular Fractures – These breaks happen at the level of the neck and the head of the femur bone and are generally within the capsule. The capsule is a soft-tissue envelope that contains the lubricating fluid that helps the hip joint move easily. When the ball or head of the femur bone is broken, repair will be aimed at fixing the cartilage. Sometimes with these types of fractures the socket itself is injured and will need repaired. For intracapsular hip fractures, our orthopaedic surgeons will either fix the fracture with individual screws or a single larger screw that slides within the barrel of a plate. This compression hip screw allows the break to become more stable. Sometimes the blood supply to the ball of the femur is damaged during injury and this leads to a condition called avascular necrosis. With this type of injury, the surgeon must realign the fracture and hold it in place with screws and plates.
- Intertrochanteric Fractures – This type of break occurs between the neck of the thigh bone and the lower boney prominence known as the lesser trochanter. This is the area of attachment for major muscles that allow the hip movement. These fractures are managed with either a compression hip screw or a special kind of nail, which will allow for impaction at the fracture site. This screw or nail is fixed to the outer side of the bone with other pieces of metal that allow for increased stability and promote healing at the site.
- Subtrochanteric Fractures – These types of breaks occur below the lesser trochanter in a region that is approximately 2 to 3 inches below. Most of these fractures are managed with a long intramedullary nail and a large lag screw. In order to keep the bones from rotating the nail or from shortening on the nail, additional metal pieces may be placed at the lower end of the nail in the area of the knee, what is known as interlocking screws.
For certain cases, the orthopaedic specialist may choose to use a plate rather than a nail and this plate will have screws that go into the bone on the sides of the femur.
Before and After Surgery
You will need to have a spinal or general anaesthesia before you have hip surgery. This involves a breathing tube or spinal anaesthesia. Most orthopaedic specialists prefer you to be having a spinal anaesthetic during the procedure for your comfort. Also, before surgery, you should have a full work-up of X-rays, urine and blood tests, and electrocardiograms to assure you are in generally good health. The surgeon’s decision as to how to best fix your fracture will be based on the area of the hip that is broken and the doctor’s familiarity with the different systems available to manage these types of injuries.
You will stay in the hospital for a couple of days after your hip surgery and will be discharged home or to a rehabilitation facility. Rehabilitation will involve physical therapy where a therapist will work with you to help you regain strength and increase your ability to walk. You will follow-up with your orthopaedic surgeon who will check your wound, remove sutures, and follow the healing process of your hip using X-rays.