Intertrochanteric femur fracture and intracapsular fracture neck femur are common fractures in hip region. Intertrochanteric femur fracture amounts to 50% of proximal femur fractures.
Incidence is common in elderly. More common in females. It second highest osteoporotic fracture and commonest osteoporotic fracture of lower extremity. Weakened bones with age, vision impairment, balance problems predisposes elderly to these fractures. In elderly usually this is result of a trivial fall while in youngsters it develops after high velocity trauma. Hip fractures almost always require surgical fixation or replacement. Maintaining bone density and preventing falls can help in minimizing hip fractures.
- Inability to get up after a fall
- Unable to walk or lift leg
- Pain in hip region
- Shortened leg
- Outwardly rotated leg
- Bruising or swelling in hip region can be seen in some patients
- Age – more common in elderly. Bone density tend to decrease with age.
- Sex – More common in females. Women develop osteoporosis early and faster than males due to hormonal changes at menopause.
- Lack of exercises – lead to weakened bones and muscles.
- Chronic medical conditions and medications – endocrine disorders, rheumatoid arthritis, corticosteroid treatment can lead to weakening of bones. Low blood pressure and low blood sugar can contribute to falls.
- Tobacco and alcohol use- can lead to bone loss.
Hip fractures can reduce mobility for long time. Complications can be as follows
- Development of blood clots in legs or chest
- Bed sores
- Chest infections
- Urinary tract infections
- Non union, malunion, delayed union
- Worsening of existing medical problems
Prevention of Hip Fractures
Maintaining healthy bones and preventing falls can prevent and reduce hip fracture incidences
- Get adequate calcium and vitamin D – Balanced diet, sunlight exposure, supplements as per advice are important.
- Regular physical exercises – regular physical exercise helps in maintaining bone density.
- Proper control of blood pressure and sugar – low blood pressure and sugar can contribute to fall.
- Vision check up – regular eye check up can reduce trivial falls at home
- Avoid smoking and alcohol – helps to maintain bone density
- Using stick while walking – useful in minimizing the number of falls in elderly
- Remove obstacles in living room – loose wires, slippery floor mats
Diagnosis and Treatment
Diagnosis is usually done by clinical examination and X ray. Further evaluation with CT scan and MRI may be needed in few patients.
Treatment depends on type of fracture, Age and medical condition of patient. Most of hip fractures require surgical intervention. Intertrochanteric fractures are commonly fixed with hip screws or proximal femoral nails. Intracapsular fracture neck femur in elderly are usually treated with partial or total hip replacement, fixation may be necessary in young patients.
If after a fall, you are unable to get up or bear weight, have pain in hip or groin, shortened or rotated leg then probably you have fracture around the hip.
If you have fracture around the hip, it is advisable to seek medical help as soon as possible.
Most of hip fractures presents with inability to bear weight/walk. However in some impacted fractures one can walk with pain.
Most of fracture neck femur and intertrochanteric fractures require surgical intervention. However it depends on Age, fracture type, medical condition of patient.
Most of people can do routine activities between 1-3 months after surgery depending on age,type of fracture and surgery performed . But it may take 6 months to a year for recovery. Some patients especially elder may not achieve pre injury level of activity.
Intertrochanteric fracture in a patient who is medically not fit to undergo surgery can be treated non operatively with derotation splint.
Fracture neck femur is treated with internal fixation, partial hip replacement or total hip replacement depending on fracture type, age and patients medical condition.
Yes, It is a major surgery.
It depends on type of surgery, age of patient and general medical condition of patient. For hemi replacement or total hip replacement weight bearing can be started couple of days after surgery, while after internal fixation weight bearing is usually started 4- weeks after surgery.
Most of prosthesis available for hemi replacement or total replacement are not compatible with squatting or cross legged sitting.
After internal fixation – one can do squatting and cross legged sitting after fracture healing.