Hip fractures are very serious orthopedic injuries, especially in the elderly. They can lead to higher mortality rates in this age group, and can require lengthy and costly hospitalization and rehabilitation.
There are several different types of hip fractures, and the treatment for most of them is surgical in nature. Because of the age group these injuries routinely affect, early stabilization of the fracture, followed by early rehabilitation can help restore a more functional activity level and also help reduce post-fracture complications.
Sub-Capital Hip Fracture
The term, sub-capital, describes the actual location of the fracture in relation to the normal hip anatomy. "Sub," meaning below, and "capital," meaning head, describes this fracture type as occurring below the femoral head, or the ball of the hip joint located on the thigh bone.
The sub-capital fracture can be either displaced (can be dislodged from its position), or non-displaced (can remain in normal anatomic position). In either case, sub-capital fractures typically disrupt the normal blood supply to the ball of the femur and the treatment differs for each one.
Non-displaced sub-capital hip fracture treatment options include restricted weight-bearing, using a walker or crutches if the fracture position is excellent and with no evidence of separation at the fracture site, or insertion of multiple long hollow screws, called cannulated screws up into the ball, securing it from any further movement.
Displaced sub-capital hip fractures usually require the insertion of a prosthesis, or partial hip replacement. This is mainly due to the significant disruption of blood supply to the ball of the hip and the overwhelmingly high risk of bone death. The procedures is typically known as a hip hemi-arthroplasty.
Femoral Neck Fracture
Moving away from the ball of the hip, towards the thigh bone, the section of bone that connects the ball with the remainder of the thigh bone is called the femoral neck. In cases of sub-capital fractures, the break occurs in the femoral neck, just underneath where the ball and neck converge.
When fractures occur further down the neck toward the thigh bone, blood supply changes, thus allowing for somewhat improved healing potential.
Femoral neck fractures are almost always a surgical situation, with fixation by way of either a plate and large screw configuration, or, as technology has evolved, the insertion of a large metallic rod into the femur, or thigh bone, that is connected to a type of screw placed into the femoral head.
Inter-Trochanteric Fracture
Two main knobs of the hip, called trochanters, have a primary responsibility for providing attachment points for tendons. These attachment points also serve to define the location of certain hip fracture patterns. When a fracture occurs between these two points, it is called an inter-trochanteric fracture. This is the most common pattern and location of hip fractures.
This type of fracture requires surgical stabilization by traditional hip pinning, or compression hip fixation, where a large threaded lag screw is inserted up into the femoral head and connected to a metallic side plate, providing a well-fixed compression and stabilization for healing.
The other method is the intra-medullary, meaning within the bone canal, rod stabilization. This is accomplished by inserting a large diameter, and frequently shorter-length, metallic rod into the thigh bone, and then connecting it to a large diameter screw device that is placed into the femoral head.
Sub-Trochanteric Fracture
As the name implies, this fracture type occurs below the level of the trochanters and into the uppermost portion of the femur, or thigh bone. The most common treatment for sub-trochanteric fractures of the hip is the intermedullary rod stabilization. This metallic rod typically is nearly as long as the thigh bone itself, in order to provide maximum fixation and stabilization while healing.
