It was a simple fall. The phone rang, she jumped to answer it. Her slipper caught the edge of the rug and she fell. But it hurt, and she was unable to get up. Finally crawling over to the phone which had long stopped ringing, she called for help. The Emergency Medical Squad took her to the Emergency Room of a nearby hospital where x-rays showed a hip fracture.
Hip fractures are a common occurrence (more than 250,000 Americans suffer hip fractures each year according to the Mayo health letter, May, 1998). Particularly at risk are middle aged to elderly females, but men are also frequently afflicted. Surgery is almost always required. Non-surgical treatments such as traction or bedrest are usually employed only when serious illness makes surgery or the accompanying anesthesia inappropriate. A long periods of traction or bed rest has its own problems including pneumonia, blood clots, bed sores or infections.
The type of surgery depends upon the portion of the hip involved in the fracture. The hip is a ball and socket joint. The area just below the ball is known as the "femoral neck." The majority of hip fractures occur in the femoral neck or just below... the "interochanteric" region. The "trochanters-- greater and lesser" are regions for muscle insertions in the top portion of the thigh bone ("femur").
Femoral neck fractures are usually repaired in one of three ways. If the bone remains aligned following the fracture, metallic pins may be inserted for "internal fixation" to hold the bone fragments securely as they heal. The femoral neck fracture, previously called the "unsolved fracture," does not, however, always heal. Therefore sometimes the surgery involves removal of the ball (femoral head) and a portion of the femoral neck and replacing it with an artificial joint (prosthesis). This might involve a total hip replacement, which replaces both the ball and socket, or a partial hip replacement (hemi-arthroplasty), replacing just the ball. If the bone fragments are not lined up well or in the older patients, the fracture is more likely to be treated with a replacement.
Fortunately the treatment is usually successful. Advances in the treatment of hip fractures (and of hip disease) are one of the greatest achievements of medicine in the 20th century. Prior to this century, for our great, great grandparents, a hip fracture would almost certainly lead to death. Evolving principles in the successful treatment of hip fractures include early surgical intervention allowing patients to get up out of bed quickly, usually within one or two days, and thereby avoid the secondary and sometimes life-threatening complications of lung diseases... pneumonia, blood clots and emboli. Other principles include anatomic or physiologic reductions ("setting" the fractures), rigid and stable internal fixation, aseptic technique, preventive antibiotic treatment, and an early return to mobilization... sitting, standing and walking. Most often this requires the help of physical therapy and walking aids... a walker, crutches or a cane. The cane becomes an important part of recovery-- allowing weakened muscles to become stronger without an accompanying limp. It is, however, the surgery-- the reduction (or replacement) of fracture fragments and rigid internal fixation-- which allows the hip to support weight long before the fracture is healed, that allows swift recovery and return of daily activity.
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Copyright © Dr. Charles A. Bertrand.
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