1. Take a Hip Fracture Seriously
Especially in older patients, complications can be life-threatening. Hospitalization and surgery are usually required. Without surgery, patients cannot walk or even sit. As a result, they become prone to developing blood clots, bed sores, pneumonia and other medical problems, which can often be fatal. Even with surgery, the chances of dying within the first year after a hip fracture are 10 to 36 percent. Only a fraction of patients are able to ambulate without the use of a cane or walker after surgery.
2. Consider the Different Types of Hip Fractures
There are three basic types of hip fractures, categorized by which part of the upper femur is affected: femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures. The femur has a greater and lesser trochanter, which are bony prominences. A femoral neck fracture is closer to the pelvis than the trochanters, towards the ball of the hip. An intertrochanteric fracture goes through the region of the two trochanters. A subtrochanteric fracture is below the level of the lesser trochanter.
3. Surgery Depends on Age and Fracture Pattern
Surgery is usually required to realign the fracture, and some sort of metal device is required to hold it in place while it is healing.
For femoral neck fractures in younger patients, or in non-displaced fractures, surgical screws can be used to hold the bones together (internal fixation). But if you are older and less active, or if the fracture is displaced, you may need a hip replacement (hemiarthroplasty). Sometimes, if the joint already has arthritis, you may need a total hip replacement, which involves replacing both the ball and the socket with a prosthesis.
For intertrochanteric and subtrochanteric fractures, a compression screw and side plate can be used to hold the broken bones in place. This allows the native head of the femur to move normally within the hip socket. The hip screw goes into the center of the femoral head. The screw allows the bone pieces to compress, as weight is placed on the fracture site. Compression is advantageous, because it promotes healing of fractures. Another option is an intramedullary nail that goes down the shaft of the femur, along with a compression hip screw.
4. Traction Can Replace Surgery as Solution
If surgery is not an option due to extreme illness, traction can be used. Traction involves placing a metal pin through the end of the femur, just above the knee. The pin is then connected to a pulley system to pull weight on the hip. This constant pull holds the bone relatively still while it heals. Unfortunately, traction takes 6 to 12 weeks, if not longer. This is not ideal, as fatal blood clots could develop, especially because the patient is immobilized in bed.
5. Expect a Short Hospital Stay as Part of Rehabilitation
Hospital stays generally last less than a week. You might be able to stand and walk again with the help of crutches or a walker. Oftentimes, elderly patients need to be in a wheelchair for a period of time. Physical therapy or rehabilitation exercises can help you regain function and strength. A hip fracture can take two to three months, up to six months, to fully heal. Rehabilitation may be needed up to a year after surgery. Even then, some patients may never again walk independently (without the aid of a cane or walker).
