Fractures
Introduction
Age, disease, and gender increase your chances of fracturing a hip. Once you reach age 50, the odds increase significantly and double every 5 to 6 years thereafter. As the population grows older, the number of hip fractures is increasing. For example, currently, some 350,000 occur in the U.S. each year.
Bones begin to weaken with age, particularly among women. It is estimated that osteoporosis, the disease that renders bones brittle and easy to break, affects more than 20 million postmenopausal women in America. With osteoporosis, your chances of breaking a bone in a fall increase dramatically. Falls are responsible for 90 percent of all hip fractures.
A woman is 2 to 3 times more likely than a man to suffer a fractured hip. And the risk for women 5’8” or taller is twice that of women who are under 5’2”.
Anatomy
A hip fracture is a partial or complete break in the upper portion of the thighbone (femur), the leg bone that forms part of the hip joint. Most hip fractures occur in the neck of the thighbone (the area just below the ball that fits into the hip socket in the pelvis), while the rest occur in the intertrochanteric area (across the outside portion of the upper thighbone).
Causes
Most people who suffer a fractured hip later in life simply trip and fall, often at home. In younger people, such fractures are rare. When they do occur, they are usually the result of a fall, a high-impact car accident, or repetitive, direct trauma caused by jogging or running.
Symptoms
Whether the break is in the neck of the thighbone or the intertrochanteric area, the symptoms are the same: excruciating pain when trying to walk or move the hip even slightly. Other possible symptoms include tenderness, bruising, and swelling of the hip, and unexplained pelvic, groin, or thigh pain.
Diagnosis
A history and physical exam will help your doctor make the diagnosis, which is confirmed with an x-ray.
Treatment
Immediate surgery is almost always required, but the type of operation
may depend on what kind of fracture you have.
If the break is in the neck of the thighbone, the fragmented ends can sometimes be realigned and fastened together with internal fixation. But a fracture across the femoral neck that interrupts the blood supply to the head of the femur can eventually cause avascular necrosis, so some doctors believe a total hip replacement is a better choice.
If the break is in the intertrochanteric area, which has a good blood supply, it is usually treated successfully with internal fixation.Internal Fixation
Hip-fracture patients with strong bones and a normal supply of blood to the thighbone are good candidates for a repair called internal fixation. In this operation, the surgeon lines up the broken ends of the bone and fastens them in place with small metal devices. By realigning the broken pieces of thighbone, the operation helps the fracture heal faster than it would on its own.This operation is done under anesthesia. After the anesthesia takes effect, the surgeon makes an incision in the hip so he can see the fractured pieces of thighbone and move them back into their proper position. Next, he inserts metal pins or compression screws to keep the bones in place. He attaches the pins or screws to the side of the fragments and the inside of the bone.During the surgery, which can last 2 to 4 hours, the doctor may have to take x-rays to make sure the pins and screws are positioned correctly. You’ll probably be in the hospital for 4 to 7 days.
Your doctor will advise you when it’s safe for you to resume driving and sexual activity. Avoid vigorous exercise for 12 weeks after surgery or until your doctor says your fracture is completely healed. Although complications are rare, there’s always a chance of infection at the site of the incision, the development of blood clots, and refracture of the hip.
For patients with bones weakened by osteoporosis, a total hip replacement is often considered the treatment of choice.
Useful link
The FRAX® tool has been developed by WHO to evaluate fracture risk of patients. The output is a 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture). Go here
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