Types Of Hip Fractures: A Patient’s Guide
What are Hip Fractures?
Hip fractures are breaks in the upper part of the femur (thigh bone) near the hip joint. These fractures are common among our elderly with osteoporosis and can result from a simple fall when they land on their buttocks. They can significantly impact mobility and surgery usually gives the best chance of recovery and restoration of mobility.
Types of Hip Fractures
Hip fractures are classified based on their location and severity. The two main types are intracapsular and extracapsular fractures.
Intracapsular Fractures
These fractures occur within the joint capsule, affecting the femoral head or neck. Healing can be complicated if blood flow is disrupted, increasing the risk of avascular necrosis. The most common type is the femoral neck fracture.
Femoral Neck Fracture
A femoral neck fracture occurs just below the ball of the hip joint. These fractures can be displaced (bone pieces shift out of alignment) or non-displaced (bone remains aligned). Displaced fractures often require surgical intervention due to compromised blood supply, while non-displaced fractures may heal with conservative treatment.
Extracapsular Fractures
Extracapsular fractures occur outside the joint capsule, typically involving the area below the femoral neck. These fractures may cause soft tissue damage but generally do not impact blood flow to the femoral head. The two main types are:
Intertrochanteric Fracture
This type of fracture occurs between the greater and lesser trochanters, two prominent bony projections on the upper femur where key hip muscles attach. These fractures can impact hip stability and function.
Subtrochanteric Fracture
This fracture is located just below the lesser trochanter and can extend toward the midsection of the femur. It affects a weight-bearing region of the bone that endures significant stress during activities such as walking and standing, making it more challenging to manage.
Symptoms of Hip Fractures
Symptoms of hip fractures usually appear immediately after the injury and may include:
Inability to move the leg: The affected leg may feel stiff, unstable, or too painful to move as the broken bone disrupts function.
Swelling or bruising: Noticeable swelling, bruising, or tenderness can appear around the hip or groin area due to internal bleeding or tissue damage from the fracture.
Shortened or outwardly rotated leg: The leg on the fracture side might seem shorter or rotated outward due to muscle contractions around the broken bone.
Difficulty walking or standing: Most people with a hip fracture often struggle to bear weight on the injured leg due to the pain and instability associated with the fracture.
Treatment Options for Hip Fractures
Non-Surgical Treatment
Non-surgical options are considered for patients who cannot undergo surgery due to health concerns. These include:
Traction
Traction uses a gentle, continuous pulling force to align broken bones and keep them in place during healing. This method can be used temporarily to stabilise the fracture before surgery or, in some cases, as part of a longer-term treatment plan. Traction helps reduce pain, minimise muscle spasms, and promote proper bone alignment while the body heals.
Bed Rest and Pain Management
In less severe cases or when surgery is not viable, doctors may recommend bed rest and pain relief through medications such as nonsteroidal anti-inflammatory drugs and opioids to facilitate natural bone healing. However, this approach poses risks, including muscle weakness, blood clots, and decreased mobility, particularly in older adults, requiring close monitoring.
Surgical Treatment
Surgery is typically required, especially for displaced fractures or those that compromise stability.
Internal Fixation
This surgical technique uses metal intramedullary nails, or plates to hold broken bones securely in place. Stabilising the bone ensures proper alignment and promotes effective healing. It is a common method for treating fractures of the femoral neck and intertrochanteric regions, followed by physical therapy to restore mobility.
Hemiarthroplasty (Partial Hip Replacement)
This procedure is used when the femoral head is severely damaged and cannot be repaired. Only the damaged femoral head is replaced with a prosthetic implant. It helps patients start walking and bearing weight on the hip more quickly compared to other treatments. This option is often recommended for older adults who are less active, as it reduces the risk of complications from long-term immobility.
Total Hip Replacement (THR)
This procedure involves replacing both the ball and socket of the hip joint with artificial components. It is generally recommended for active older adults dealing with severe fractures or joint damage from arthritis. Recovery often requires several months of physical therapy.
Conclusion
Hip fractures are serious injuries, particularly for older adults, that require timely and appropriate medical attention. Learning about the types, symptoms, and treatment options can help ensure the best outcomes. While surgical intervention is often necessary to restore mobility and quality of life, non-surgical approaches may be considered for those with health concerns.
If you suspect a hip fracture after a fall or are experiencing severe hip pain, schedule a consultation with Dr Kau to receive personalised care and tailored treatment options for a quicker recovery.
