Hip Fractures: Femoral Neck and Inter/Sub-Trochanteric
Introduction
Hip fractures can occur at any age, but the vast majority occur in the elder as their bones become progressively more osteoporotic (and therefore brittle) with age. When we talk about a hip fracture, we are almost always referring to a break in the ball side of the “ball and cup” joint.
Anatomy
The hip joint is a true “ball and cup” articulation. The “cup” (acetabulum) is the part of the pelvis where the three bones of the pelvis, the ischium, the ileum, and the pubis, join together. The “ball” is the head of the femur or thighbone. Around the bones are the ligaments, called the capsule. And, around the capsule are the muscles.
The head of the femur (‘the ball”) is attached to the neck of the femur which in-turn goes into an area called the intertrochanteric and then the subtrochanteric regions of the femur. There is great blood supply to the inter- and sub-trochanteric regions of the femur and injury to one of these areas will usually heal in time. The blood supply to the head however comes from blood vessels, which travel up the neck of the femur. So a fracture in the neck of the femur injures the blood vessels to the head and the potential for healing a neck fracture is markedly diminished.
Treatment Options
Hip Replacement
When the break is in the neck or the “ball” of the hip, the likelihood healing is very slim. The replacement option will be either a hemi-arthroplasty (HHA) or a total hip replacement (THA).
Repair
When the break is in the area beyond the neck, the break can be repaired with a good chance of the fracture healing. There are a number of methods that can be used to fix the fracture. The actual method used will be determined by the actual fracture pattern and location along with the physician’s experience.
Post-Operative Course
Hip Replacement
The first day after surgery, therapy will be started. In most cases, weight may be placed on the operative leg. The therapists will teach exercises, how to walk with a walker, the correct way to do things, and what to things to avoid. Activities will be added as the patient is able.
Repair
The first day after surgery, therapy will be started. In many cases, the patient may not place weight on the operative leg. When the patient can’t put weight on the leg, this will usually be for 8 weeks. The therapists will teach exercises, how to walk/hop with a walker, the correct way to do things, and what to things to avoid. X-rays will be taken every 4 weeks and weight-bearing and activities will be progressed as appropriate.
Important things to know about hip fracture
- About 25% of elderly patients with a hip fracture will be able to return to their pre-injury level of activities.
- Many people will always have to use some type of assistive walking device.
- There is as much as 30% mortality rate, in the elderly, in the first year after the fracture. (This is regardless of the type of hip fracture and treatment method.)
- Please see the consent form for a more complete list of the possible problems with a hip fracture and the treatment.
Written by James A. Shapiro, MD