Features December 2018 Issue

Repairing a Fractured Hip

A hip fracture can be a serious, life-altering event. Surgery can repair it, but it's best to prevent it.

Falling can be hazardous for anyone. But as we age, bone density decreases, and falls are more likely to result in a broken bone, including at the hip. Every year, over 300,000 people ages 65 and older are hospitalized for hip fractures. Over 95 percent of them are caused by falling, usually sideways.

As the baby boom generation ages, hip fractures are on the rise. "This is a severe injury for an older adult, especially someone with fragile health," says Cleveland Clinic orthopaedic surgeon Michael Bloomfield, MD.

Hip fractures usually require surgery, and the sooner the better. "Studies show that patients have improved outcomes if they have surgery within 24 hours of a hip fracture," says Dr. Bloomfield.

After the Fall

hipfracture

Raycat | Getty Images

A hip fracture can occur in the section of the femur near the ball (femoral neck).

Once at the hospital, you will get an examination and an X-ray. If there is any uncertainty, a more advanced imaging test, such as a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan, may be done to look for hairline fractures. If there is a fracture, the need for surgery will depend on the location and pattern of the break.

Hip Anatomy

hipfracture2

Raycat | Getty Images

A hip fracture can also occur farther down in the intertrochanteric region.

The hip is the joint where the thigh bone (femur) meets the pelvis. A ball at the top of the femur fits into a socket in the pelvis. The section of bone between the shaft of the femur and the ball is called the femoral neck. The part farther down on the upper femur is the intertrochanteric region.

A hip fracture is a break in either the upper part of the femur, including the femoral neck and intertrochanteric region, or the pelvis. "Some fractures in the pelvic bone will heal without surgery," says Dr. Bloomfield. But fractures that occur in the femur are almost always treated with surgery, unless there is a reason the person cannot undergo surgery.

The Surgery

If the fracture is in the femoral neck and the bones are not displaced (meaning they are still in alignment), the broken sections can be held together in their correct position with metal screws while the bones heal. However, if the bones are no longer aligned, the best approach is a partial or total hip replacement.

With a partial replacement, the ball portion of the femur is replaced with a metal implant. The socket in the pelvis does not require surgery. A total hip replacement involves replacing both the ball of the femur and the socket in the pelvis with a metal and plastic implant. This is the same surgery that is done for severe hip osteoarthritis.

Surgery for a fracture in the intertrochanteric region, involves using a metal rod or plate that goes down the femur and screws to hold the bones together.

Recovery

Most people who have surgery for a hip fracture go to a rehabilitation facility from the hospital. The amount of time required depends on a number of factors, including the overall health of the person and the amount of support they have from family at home.

Dr. Bloomfield cautions that people who've had a hip fracture should have realistic expectations. Surgery can fix the break in the bone, but the recovery can take six months to a year. During that time, you will work with a physical therapist and occupational therapist.

Some people fully regain their normal function after the recovery period. But many people never return to the level of function they had before the fracture.

Older adults who have a fracture, whether of the hip or another bone (such as the wrist or spine), are at higher risk for having another fracture. "One thing that should happen after a hip fracture is to get a bone density test if you haven't already had one," says Dr. Bloomfield. Even if you low bone density that does not quite meet the criteria for osteoporosis, you will probably be given an osteoporosis medication.

A recent study, published in JAMA Network Open (July 2018), found that only about 3 percent of 97,000 people who had a hip fracture and were not previously taking an osteoporosis medication were prescribed one within six months of being hospitalized. If your doctor doesn't mention it, ask about getting a bone density test.

Focus on Prevention

About 40 percent of older adults who suffer a hip fracture ultimately lose their independence, requiring long-term care. This is a scary statistic and a good reason to do all you can to focus on prevention. Up to half of all osteoporosis-related fractures can be prevented, according to the Natioanal Osteoporosis Foundation.

The keys to prevention are to keep bones strong, get a bone density test, take medication if you have osteoporosis and prevent falls (see box).

"Ultimately, prevention is the best treatment," says Dr. Bloomfield. "But not all falls are preventable, so keep your cell phone with you at all times if you feel unsteady."

Getting Help if You Fall

lifealert

SolStock | Getty Images

If you fall and can't get up (just like in the TV commercial), call 911 immediately. Michael Bloomfield, MD, advises everyone who is at risk for falling to always keep their cell phone with them or wear a medical alert device (such as Life Alert). If you fall and don't get help for a prolonged period of time, the consequences can be serious. You may become dehydrated, and muscles can break down, releasing chemicals that can cause kidney damage. SolStock | Getty Images

What You Can Do to Prevent Hip Fracture

Keep Bones Strong:
- Get enough calcium (1,200 mg a day) and vitamin D (600 to 800IU a day).
- Engage in weight-bearing exercise (such as walking) 30minutes a day three to four times a week.
- Get screened for osteoporosis with a bone density test.
- If you have osteoporosis or osteopenia, take the medication your doctor prescribes.

Prevent Falling:
- Review the medications you take with your doctor to see if any of them can cause dizziness or sleepiness, which can increase your risk for falling.
- Get your eyes checked, and update your eyeglasses if needed.
- Address balance problems
- Do strength and balance exercises (such as tai chi).
- If you feel unsteady, use a cane, walker, or other assistive device.
- Safeguard your home (eliminate trip hazards, install grab bars in the bathroom and other areas where needed, and make sure your home is well lit).

Comments (0)

Be the first to comment on this post using the section below.

New to Arthritis Advisor? Register for Free!

Already Registered?
Log In