Approximately 340,000 people in the United States break a hip each year, most often because of a fall, according to the Merck Manual of Geriatrics. Half of the patients are 85 years old or more. Patients who are too frail for surgery may be placed in traction--a system of ropes and pulleys--until the bone heals. Surgical options including replacing part of the femur; replacing the hip joint; or an open reduction and internal fixation--ORIF--that stabilizes the broken bone with metal hardware. Unless complications occur, the ORIF results in a nearly normal hip when it heals.
Avascular Necrosis
Open reduction and internal fixation of the hip is a less invasive procedure than hip replacement and causes less blood loss. However, it may cause avascular necrosis--bone death due to interruption of the blood supply--as late as three years after the surgery, according to Simon Mears, M.D., Ph.D., chief of Total Joint Arthroplasty and Trauma at Johns Hopkins Bayview Medical Center. Elderly patients with weak, brittle bones from osteoporosis are most likely to develop this complication. Delaying surgical repair for more than 24 to 48 hours after the injury also contributes to the development of avascular necrosis, according to Wael Barsoum, M.D., in a report published in the March 2006 issue of the "Cleveland Clinic Journal of Medicine." If avascular necrosis develops, the hip must be replaced with an artificial joint.
Non-Union
The risk of non-union or failure to heal is higher in those who undergo ORIF than those whose hips are replaced, according to Mears. If the hardware does not stabilize the bone adequately, the fracture will not heal and the screws will slip. The risk of non-union is lower in patients younger than 50 than in the elderly and those with osteoporosis.
Delirium
As many as 61 percent of patients undergoing surgery for a hip fracture develop short-term delirium or an acute confusional state, according to Barsoum. Delirium lengthens the hospital stay and is associated with more complications. Risk factors include a history of drinking alcohol, poor health, cognitive disorders, and advanced age. Anesthesia, pain medication, infection, low blood pressure, and poor nutrition contribute to the development of delirium after hip fracture surgery. Using lighter anesthesia and avoiding overmedication help to prevent or limit this complication.
General Risks
Patients undergoing hip surgery are at risk for developing blood clots that could break off and travel to the lungs, a potentially fatal condition, according to MayoClinic.com. They are also at risk for infection, pneumonia, urinary retention and urinary tract infection, notes Barsoum. As many as 45 percent of hip fracture surgery patients develop these common complications.
