Hip fractures are a serious orthopedic problem, especially in the elderly. They can significantly impact a person's ability to be self-sufficient and seriously impair mobility, even after healing. According to the Centers for Disease Control, over 95 percent of hip fractures in this age population are a result of falls. Each fracture has its own type of treatment.
Subcapital Fracture
Subcapital fractures occur at the junction between the femoral head, or ball of the thigh bone, and the femoral neck, or stalk, that connects the ball with the rest of the thigh bone. This type can be troublesome in that the injury can damage blood vessels that supply the femoral head. This in turn increases the potential for avascular necrosis, which is death of the ball due to damaged blood supply. When bone death occurs, it begins to collapse and deteriorate.
In some cases where the fracture is considered nondisplaced and the ball is in perfect anatomic position, surgical fixation with large screws can be performed to stabilize the fracture and allow for healing. Otherwise, in displaced fractures, partial hip replacement is indicated. This is known as hemiarthroplasty.
Femoral Neck Fracture
This fracture occurs within the length of the femoral neck, the stalk, that connects the femoral head, the ball, to the remainder of the thigh bone. The location of the fracture line will determine what corrective procedure is to be performed, again because of the close proximity of vital blood vessels that feed the femoral head.
If the fracture occurs close to the end of the neck opposite the femoral head, there is increased potential for healing without partial replacement. A stabilizing internal fixation procedure known as in situ fixation--meaning it its current position--can be performed. This is accomplished typically via the insertion of 1" to 3", partially threaded screws that pass through the fracture site into the femoral head. The screws are tightened enough to stabilize the fracture.
In injuries where the fracture occurs farther along the femoral neck, closer to the head or ball, the risk of healing failure rises accordingly.
Intertrochanteric Fracture
The majority of fractures caused by falling result in intertrochanteric hip fracture. It is also known as the "garden variety" hip fractures. Intertrochanteric fractures occur at a point where the two larger bony prominences of the hip, the greater and lesser trochanters, are located. These trochanters serve as tendon attachment points for muscles that help move and stabilize the hip.
Because of the location, healing potential is good, but surgical fixation is still required, mostly to restore the proper position and alignment of the bony components and to prevent motion at the fracture while healing occurs.
Subtrochanteric Fracture
This fracture occurs at a point below the two trochanteric attachment points of the hip, typically where the shaft of the thigh bone commences. This fracture can be troublesome to treat. Because of the location of the fracture, forces on the upper portion of the hip exerted by the various attached muscles can cause abnormal rotation and other positional changes, making reduction and restoration of acceptable alignment difficult at the very least.
One form of treatment is the use of a full-length femoral rod that works with a very large-diameter threaded screw device inserted into the femoral head and connected to the rod that is inserted down the internal shaft of the thigh bone. Locking the two metal components together creates a strong and stable construct for healing.
