Hip fractures can be devastating injuries, especially in the elderly. According to the American Association of Orthopedic Surgeons, only 25 percent of hip fracture patients make a full recovery, while a staggering 24 percent of those over 50 who suffer a hip fracture will die within 12 months of the fracture. Treatments for a hip fracture vary depending upon the type and severity of the injury.
Protected Weight Bearing
Some hip fractures can be considered hairline and non-displaced, meaning that even though there is a fracture line visible on x-ray, the hip remains in perfect anatomic position and vital blood supply to the femoral head, or ball of the hip, has not been disrupted. In this somewhat less common scenario, treatment may consist of merely placing the patient on strict limited, or partial weight bearing to avoid any risk of further displacement of the fracture until sufficient healing has occurred.
Internal Screw Fixation
Some types of hip fractures, mainly those whose chances of adequately healing without having to perform a replacement procedure are high, can be treated and stabilized with insertion of three long, typically hollow, threaded screws that thread up into the ball of the hip and secure it from moving at the fracture site, which is typically located at the base of the femoral neck, away from the hip joint proper where blood supply is better for healing.
Compression Plate and Screw Fixation
One of the most common hip fractures is the inter-trochanteric fracture. The fracture occurs at or near the base of the femoral neck, which serves to connect the ball to the rest of the femur or thigh bone. There are two bony prominences called trochanters that serve as attachment points for tendons of the muscles surrounding the hip. Fractures of this type frequently occur through, or involve these trochanters, hence the name. This fracture type is most amenable to non-replacement surgical repair because of the amount of stability that can be achieved as well as optimum healing potential.
The repair involves the insertion of a large bore threaded screw up into the ball of the hip. This screw is then attached to a metallic plate which sits outside the bone along the outer aspect of it just below the trochanters. The large screw and plate are connected and the plate is secured to the thigh bone by way of several smaller screws. This construct holds the fracture together and provides substantial stability for early post-operative rehabilitation. The common name for this procedure is the hip pinning.
Intermediullary Rod Fixation
Similar fixation of hip fractures are obtained by inserting a metallic rod down the inner canal of the thigh bone and connecting it to a large threaded screw or other fixation equivalent up into the femoral head. This construct, like the compression plate and screw version, established considerable fixation strength that allows for maximum healing opportunity and early mobility for rehabilitation.
Hemi- Arthroplasty
Hemi arthroplasty procedures involve the surgical removal of the broken femoral head, or ball of the hip and replacement with a prosthetic component, usually a large diameter ball with a stem for insertion into the femoral canal. Hip fracture damage is typically isolated to the femoral side of the hip, mainly the femoral head, or ball. In fractures where the ball is sufficiently displaced from is attachment point to render healing impossible, replacing it with a type of prosthesis is warranted. The acetabulum, or socket of the joint, is usually not damaged or otherwise affected to the point of requiring a prosthetic cup insertion, so the term hemi, meaning half, describes a partial replacement of the femoral head only.
This procedure offers the most reliability, stability and opportunity for early recovery than the fixation varieties, although it can, at times, be a more involved surgical procedure.
