Hip fractures constitute major factors in the mortality and morbidity rates among the elderly. According to the Centers for Disease Control and Prevention, published statistics that show approximately 20 percent of all hip fracture patients die within the first year after sustaining the injury, and approximately 25 percent of people who were independent in their activity were unable to return to that level. Several hip fracture procedures exist to help deal with this enormous problem.
Hemi-Arthroplasty
Hemi-arthroplasty of the hip refers to a procedure in which only part of the entire hip joint is replaced as a result of the fracture type. This procedure consists of removal of the broken femoral head, or ball of the thigh bone, and insertion of a prosthetic stem with a large artificial ball attached to it. This procedure is typically performed on a patient whose acetabulum, or hip socket, is undamaged and not in need of replacement. It is also performed as a rapid procedure in the very old and medically unhealthy patient where surgery is mandated.
Depending on the age and activity status of the individual, the ball of the femoral prosthesis can be either a large stationary ball, called an endo-prosthesis, or a movable ball within the host socket called a bi-articulate or bi-polar prosthetic head.
In-Situ Fixation
This procedure consists of the placement of three cannulated, or hollow, screws up into the ball of the hip for proper stabilization of the fractured femoral neck. It is typically performed on fractures that are stable, non-displaced and in proper alignment, offering the best chance for healing. The term in-situ refers to fixation of a fracture in its present position, without manipulation or correction
Hip Nailing
Trochanteric femoral nailing is a procedure in which a short metallic nail, or rod, is inserted into the proximal, or upper, end of the thigh bone at the hip area and passes through the fracture site internally via the bone canal. A large bore screw is then inserted up into the ball of the femur, and the screw and nail are then locked into place with each other. This creates a quite strong fixation, frequently allowing for early partial weight bearing.
This procedure is quite popular for dealing with the more common inter-trochanteric fracture because it is typically minimally invasive, with shorter surgical times, and allows for rapid mobilization of the patient in order to minimize complications.
Total Hip Replacement
Total hip replacement refers to the resurfacing of both the femoral head, or ball of the femur, and the acetabulum, or hip socket, with prosthetic implants. In cases of fractures in younger and/or highly active patients, total replacement may be determined to be the best option for longevity of the implants. While mostly done as an elective procedure for degenerative arthritis, total hip replacement remains a valuable tool for patients whose activity status and age are appropriate.
Similar to a hemi-arthroplasty, the broken femoral head is removed. A prosthetic stem is then inserted into the canal of the thigh bone. The socket is then scraped clean of its joint cartilage and reamed to a specified diameter and depth. A spherical, prosthetic cup is then inserted into the socket and fixed into position by various methods. The new ball of the hip can be of various sizes and materials, and the opposing surface of the socket is typically made of polished metal, plastic or ceramic material.
