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TREATMENT OPTIONS FOR HIP FRACTURE (SURGICAL AND NON-SURGICAL)

Mersad Alimoradi 20 Oct 2021
TREATMENT OPTIONS FOR HIP FRACTURE (SURGICAL AND NON-SURGICAL)

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A hip fracture is a break in the bone that makes up your hip joint. It can happen to anyone, but it’s a common injury among the elderly. Accidents aren’t the only cause of hip fractures. Various factors, like medication and lifestyle choices, can make you vulnerable to fracturing your hip.

There are several non-surgical and surgical treatments for hip fractures. These treatments can range from physical therapy to bone stimulation, or even total hip replacement. If left untreated, your hip fracture may lead to severe complications.

Read on to learn about hip fractures and the best treatment options to fix them.

What Is a Hip Fracture?

A hip fracture is a break in the thigh bone or femur of your hip joint. It can involve a single break or multiple breaks in your bone. A hip fracture is a severe injury that needs immediate medical attention since it can be excruciating and often comes with life-threatening complications.

About 260,000 and 300,000 cases of hip fractures occur in the US annually. Experts project it to reach around 500,000 yearly cases by 2040.

Statistics show hip fractures occur most commonly among older adults 65 years and above. The risk of a hip fracture increases as you age since the bones weaken. 

What Causes a Hip Fracture?

Hip fractures are most commonly caused by trauma, however, they can happen spontaneously in some people. Various causes and factors can contribute to fractures of the hip:

  • Accidents: Slipping and falling are the most common accidents resulting in a hip fracture - mostly in elderly adults whose bones are weak and likely to break. In the younger population, a vehicular accident, sports injury, or severe trauma can lead to a hip fracture
  • Medications: Long-term use of steroids like cortisone and prednisone weakens your bones. These medications commonly treat asthma and arthritis, among other conditions. Thyroid hormone replacement drugs for hypothyroidism are also associated with bone loss, making you vulnerable to fractures. 
  • Calcium and Vitamin D Deficiency: Childhood is a crucial time for bone development. Young people who lack calcium and vitamin D in their diet are more susceptible to hip fractures. As you grow older, calcium and vitamin D are essential in maintaining your bone mass and protecting you from developing hip fractures quickly.
  • Inactive Lifestyle: Are you glued to your workstation most of the time? Hip fractures can result from a lack of physical activity and weight-bearing exercise. Being inactive weakens your muscles and bones, putting you at a greater risk for hip fractures.

How Is A Hip Fracture Diagnosed?

At the hospital, many cases of hip fractures are diagnosed through a physical evaluation. However, your doctor may request imaging tests to provide insight into the details of your fracture to help decide the treatment for you:

  1. Physical Examination: Your doctor checks your body to make sure you don’t have any other injuries. They check your leg and thigh for abnormalities. Often, the injured leg will appear shorter or twisted in an abnormal position. Your doctor may also need to inspect the sensation and circulation to your affected leg.
  2. X-ray: An X-ray is the first and standard imaging test for fractures. X-rays show images of your bone and the fracture. Most hip fractures are diagnosed with an X-ray. This imaging test can also determine the type of fracture you have.
  3. Magnetic Resonance Imaging (MRI): MRI scans reveal more refined images of your bone and the surrounding tissues. It detects small or shredded fractures, which are not visible on an X-ray.
  4. Computerized Tomography (CT) Scan: A CT scan gives a more detailed and cross-sectional image of your fracture. It can provide your doctor with the necessary information to treat your fracture.
  5. Bone Scan: In some cases, your doctor can order a bone scan. Bone scans are imaging tests that can reveal problems with your bone metabolism that may have led to your hip fracture. They inject a specific dye into your broken bone before they scan it. The dye allows even the tiniest details to appear, like cracks and pieces of the broken bone.

How Is A Hip Fracture Treated?

Hip fracture treatments may vary depending on the severity of your condition. A study reveals non-surgical conservative management is appropriate for people who are unfit for surgery. Your doctor may suggest non-invasive treatments if you are medically unstable, severely debilitated, or suffer from a terminal illness.

Conservative treatments aim to relieve symptoms of hip pain. Often, there is no significant difference in the functional outcome as compared to surgical treatment.

Most other cases of a broken hip will need to be treated through a type of surgery. Doctors will most likely recommend surgery to a functionally healthy elderly patient for faster healing and recovery. Treatment for hip fracture usually involves surgery, medication, and post-operative rehabilitation.

Non-Surgical Treatment

Your broken hip may not need surgery. If you’ve had a fracture for some time and only approached your doctor when the bone had started to heal, you won’t require surgical treatment. Although, it’s not advisable to let a hip fracture go unattended. It may lead to severe and permanent disability.

Some patients may also refuse to undergo surgery. That’s where conservative treatments come in. These include specific therapies and devices that help relieve pain or discomfort and prevent further injury.

Assistive Devices

With a break in your hip, take it easy for at least 6 weeks. You’ll need to refrain from strenuous activities and putting weight on your affected hip until it heals.

That doesn’t mean you have to be confined in bed. In fact, it would help if you moved about to prevent deep vein thrombosis, blood clots because of loss of movement. For the time being, you can use assistive devices such as a cane, crutches, or walker to help you move about. These devices are convenient for easy movement without the stress on your hip. 

Electronic And Ultrasonic Bone Stimulation

Bone stimulation treats fresh and nonunion fractures or bones that failed to fuse correctly. A device is used to deliver low-electric current, low-intensity ultrasound, or extracorporeal shock waves to your bone. It is said to speed up the repair of your hip fracture.

Although electrical stimulation can cause decreased pain and improved function, a review of trials has found no significant bone healing outcomes. More studies have yet to validate the effectiveness of this treatment.

Bone stimulators have no known direct adverse effects. However, doctors caution children and pregnant women against the treatment since further clinical trials have yet to prove bone stimulation’s safety and efficacy among this population.

Physical Therapy (PT)

Your doctor may refer you to a physical therapist before and after surgery. Exercise pumps oxygenated blood supply and nutrients to your affected bone, promoting faster healing.

Sometimes, your doctor and physical therapist may approve bed rest with weight-bearing exercises. Your physical therapist can instruct you to perform simple stretching and range-of-motion exercises.

You benefit from PT in three ways. First, it prevents your muscles from becoming weak. Second, it increases your flexibility. And third, it improves your range of motion. The duration and frequency of PT activities will depend on your condition. Working with a physical therapist will help heal your hip fracture and keep your muscles strong.

Traction

Your surgeon can use pulleys and weights to stretch the muscles around your broken hip. They are installed and attached to your leg during your hospital stay. The traction keeps your muscles in place as the fracture heals. This type of non-surgical hip fracture treatment is done in certain cases, like intertrochanteric fractures (see below).

Surgical Treatment

Your hip bone has a socket that houses your femur or thigh bone, and together they make up your hip joint. There are three areas of fracture, which usually involve the femur. For each type of fracture, there are different types of surgery.

Intracapsular fracture - A break at the ball or neck of the femur. This is also known as a Femoral Neck Fracture. Surgical options include:

  • Internal fixation: If you have a femoral neck fracture, your surgeon secures the displaced fracture with pins, screws, and a metal plate that runs down your femur to hold the bone together as it heals.
  • Hemiarthroplasty: Hemiarthroplasty is a partial hip or joint replacement. If only the end of your bone is damaged, your surgeon may remove only the ball of your fractured femur and attach a metal replacement. Surgeons usually recommend a partial hip replacement for patients who don’t live independently or with other health conditions.
  • Hip replacement: A total hip replacement or arthroplasty involves the hip socket, unlike hemiarthroplasty. Your surgeon reconstructs your joint by cementing an artificial socket to your hip. They then replace the damaged femoral ball with a ceramic or metal ball that fits the artificial socket.

Total hip replacement is the gold standard for treating hip fractures in otherwise healthy patients who live independently.

Intertrochanteric fracture - A break between the greater and lesser trochanter of the neck of the femur.

  • Internal fixation: Fixation is the insertion of sliding hip screws or intramedullary hip screws that keeps the bone in the proper position. Your surgeon also inserts a plate under your femur for support and realignment while it heals. You may be immobilized for about 4 to 8 weeks for full recovery or until your hip fracture fully heals.

Subtrochanteric fracture - An uncommon break at the lower part of the trochanters of the femur.

  • Internal fixation: This is the gold standard surgery for subtrochanteric fractures. Your surgeon uses screws to secure a long pin or intramedullary nail. A study shows it lessens your time in surgery and hospitalization and lowers the risk of failure.

Recovery After Hip Fracture Surgery

For non-surgical treatments of hip fractures, it may take around 12 weeks of bed confinement. However, your doctor may recommend weight-bearing exercises you can do in bed. This helps you improve your range of motion and muscle strength even with limited movement.

In comparison, after surgery, you can usually walk on your own or with assistive devices as early as the first or second day. Recovery usually takes 6 to 8 weeks, during which the bone heals and you will gradually regain your range of motion. Full recovery might take months in some patients, and physical therapy is recommended to speed up healing.

The long recovery process may sound discouraging for hip fracture patients. However, it is essential to allow your bone to heal correctly and completely.

FAQs

  • What are the risks of hip fractures? Other than falling or trauma to your hip, several factors put you at risk of fractures, such as age, sex, race, low bone mass, low body weight, estrogen deficiency, cigarette smoking, chronic alcoholism, diabetes mellitus, and osteomalacia (a disease that causes soft bones).
  • Is a hip fracture dangerous? A hip fracture can be life-threatening due to pre- and post-operative complications. A hip fracture can lead to internal bleeding, infections, blood clot, pulmonary embolism, or stroke.
  • Are non-surgical treatments for hip fractures effective? A study points out that non-surgical methods pose higher risks for complications and death than surgery in an elderly patient. However, determining the type of treatment can be complicated and depends on many factors. Consult your doctor on the best treatment for your broken hip.
  • Are medicines effective for hip fractures? Medications like acetaminophen work to ease your pain. Your doctor can prescribe you a more potent pain killer if needed. It allows you to perform exercises during your rehabilitation as your bone heals.
  • Are NSAIDs safe for pain? Non-steroidal inflammatory drugs (NSAIDs) reduce inflammation that relieves hip pain. But inflammation plays a role in healing. Your doctor may not recommend NSAIDs since they can delay the recovery of the fractured bone.
  • What are the complications of a hip fracture? Research reveals that the rate of complications after hip fracture is high. Only a few cases were considered preventable. The most common conditions were delirium, pneumonia, and congestive heart failure. Immediate surgery within 48 hours of your hip fracturing can decrease your risk of developing complications.
  • Can I walk again after hip surgery? Yes, you can walk again after a hip surgery. The time of recovery depends on the nature of your fracture. Bone healing, muscle strength, and full recovery may take around 3 to 6 months. You can walk on your own or with assistive devices as early as a day after surgery. After a few weeks, you can resume your daily activities.

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About the Author:
Mersad is a medical doctor, author, and editor based in Germany. He's managed to publish several research papers early in his career. He is passionate about spreading medical knowledge. Thus, he spends a big portion of his time writing educational articles for everyone to learn.

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