Hip fractures are fractures of the "neck" of the femur; the long bone that comprises the upper part of the leg. The femoral neck is the area between the shaft of the bone and the head of the femur (the "ball" that fits into the "socket" of the hip).
Hip fractures are a major public health problem. In the U.S., the cost of hip fracture is approximately 7 billion dollars annually, and hip fracture is the second most common cause of admission to nursing homes, accounting for some 60,000 admissions each year.
Osteoporosis in the elderly contributes to most of these fractures. Many elderly patients who break a hip face a broad array of problems that transcend the treatment of the injury itself. In many cases, an elderly person's independent existence is impacted by a fall that causes a hip fracture, an event that can forever lessen the patient's level of function. Medical treatment for hip fracture can lead to complications in older people depending on their health status.
Rehabilitation from hip surgery often is prolonged and discouraging to aged patients anxious to return to their homes. Confusion and agitation result from depression, a condition often experienced by the elderly when they have been removed from familiar surroundings and brought to the hospital environment.
This injury may be complicated by the failure to regain the ability to walk, sores resulting from persistent pressure on the skin during confinement to bed, pneumonia, confusion and dementia (decreased intellectual functioning).
The most common cause of hip fracture is injury.
It is estimated that one in four women surviving to the age of 90 years will suffer a hip fracture.
A person with a suspected fracture of the pelvis should not move, since this can cause damage to the pelvic organs. A fracture should be suspected if there is pain in the hip, groin, lower back or suprapubic area, especially with movement of the leg. One should observe these precautions:
Do not move unless absolutely necessary.
Do not permit any movement of the torso or legs. With a pelvic fracture, this may be achieved by tying the legs together at the ankles and knees and transporting on a firm surface (backboard). With a hip fracture, the leg may appear to be shortened and rotated out.
Do not attempt to straighten it.
- Look for signs of shock and treat appropriately.
- Call an ambulance.
Hip fractures can almost always be repaired with orthopedic surgery. The usual surgery involves opening up the hip joint and placing a pin internally through the neck of the femur into the femoral head. Sometimes other "hardware" is used to keep this pin stable until the fracture is healed. New fixating techniques are being used to securely stabilize fractures, enabling individuals to get out of bed shortly after surgery.
An important aspect of hip surgery is the team concept involving orthopedic specialist, nurses, physical therapists, social workers, family and friends. This helps address and avoid many of the problems that reduced function from a hip fracture can create. Home care programs for the elderly are becoming increasingly popular.
Most elderly patients who fracture a hip continue to decline in health one year after discharge from hospital. One study found that most recovery took place within the first six months, and that few patients fully regained their pre-fracture ability to perform the activities of daily living.
Patients were less likely to recover quickly if they were older, cognitively impaired, had longer hospital stays, were rehospitalized or displayed symptoms of depression. Patients who maintained social contacts during their first two months out of the hospital recovered more rapidly than patients without ready access to family and friends.
How serious is the fracture?
What type of surgery will be performed?
What outcome should be expected from the surgery?
How long of a hospital stay should be expected?
What can be done to help improve the recovery period?
After surgery what can be done to help prevent another fracture?
Treatment with estrogen, calcium or calcitonins may decrease the risk of a hip fracture in older women. These drugs may help decrease the rate of bone loss in women with osteoporosis, a disorder characterized by loss of bone mass. Research indicates that women taking estrogen, calcium or calcitonin had a significantly lower risk of a hip fracture than those who were not. Women who had been treated longest had the lowest risk. Calcium and calcitonin had a similar effect in older women as in younger women, but estrogen was more effective in preventing hip fractures in younger women.
Physical activity is also a very important method of preventing bone loss. Exercise reduces the risk of bone loss by almost one-half.
Discontinuing smoking women before menopause reduces the risk of hip fracture by 25 percent.