Hip fractures
You can have a hip fracture at any age, but most often these fractures occur in people older than 65.
Over time, the bones lose their density and become osteoporotic. This progressive loss of bone density is at the origin of loss of resistance, likely to lead to a hip fracture, even after a minor trauma.
These fractures may lead to important complications especially in elderly patients. Fortunately, care of these fractures is currently well provided, and full recovery is obtained in most cases.
These fractures are most often found at the femoral neck or trochanteric massif (proximal part of the femur). Usually, in case of fractures of the femoral neck (at the elderly), we opt for the placement of a prosthetic hip (intermediary or full), while for trochanteric fractures, osteosynthesis is the preferred technique.
For the osteosynthesis of these types of fractures, we use special implants, which will be discussed depending on the type of fracture.
I prefer osteosynthesis by minimal percutaneous incisions with centromedullary implants that allow quick mobilization of the hip operated, with early resumption of walking.
Diagnosis
Patients often see a doctor as a result of a fall, when they areinable to move their legs and feel severe pain in the groin; any support on the leg is impossible and the lowest hip mobilization is painful. The foot is most commonly rotated outwards.
Treatment
Usually patients are taken to the ER by ambulance or family.
A hip X-ray is performed at arrival and surgical opinion of the doctor on-call is required, who assured the hospital stay organization. If the diagnosis of hip fractureis confirmed, surgical recommendation will be made by the surgeon who provides care for thistype of fracture.
For femoral neck fractures, we usually propose a total hip replacement (depending on age; if the patient is older than 75, we can discuss the opportunity of an intermediate prosthesis). The surgeon can choose between cementless or cemented prosthesis. Most often, for the elderly, I propose a cemented prosthesis, given the existing osteoporosis. After mounting a hip prosthesis, rehabilitation is followed as in the cases of total hip replacement for arthrosis (see Chapter “Hip arthrosis”).
On the contrary, if the fracture affects especially the proximal part of the femur (trochanteric region), osteosynthesiswill be provided.
Après la mise en place d’une prothèse de la hanche la rééducation se poursuit comme pour les cas prothèse totale de hanche pour arthrose (cf chapitre arthrose de la hanche).
Osteosynthesis with a suitable implant is performed percutaneously with incisions rarely exceeding 5-6 cm.
After osteosynthesis, walking resumption is authorized depending on the type of fracture. For some fractures, resumption of walking could take a week after surgery, while in case of certain complex fractures, resumption of walking will be authorized 3 to 6 weeks after surgery. Suitable rehabilitation is proposed according to the surgical technique used.
Possible complications
These types of interventions are sometimes, but not often, associated with complications such as:
Deep vein thrombosis, which is why antithrombotic prophylaxis is recommended, by injections patients should administrate for thirty days after the surgery, one injection per day.
Urinary infection
Pneumonia
Loss of muscle strength -> rehabilitation is proposed, adapted mostly to ensure a speedy recovery of the muscle strength
Haematoma
Infection
These complications are (in theory) common for almost all surgeries but due to the preventive measures implemented, they are becoming less common.
Patients leave the institution after 7 to 10 days; depending on several factors (environment, age, general condition,…). They return home or are transferred to the rehabilitation department.
When leaving the hospital, patients receive prescriptions for antithrombotic sub-cutaneous injections (Clexane).
Special compression stockings should be maintained for 4-6 weeks.
Rehabilitation will be according to the type of intervention: total support for complete hip prostheses or partial under the protection of a supporter or crutches for hip fractures.
Patients are seen again by doctors in one week after hospital discharge, when stitches are removed, and four weeks after surgery, with a control X-ray of the hip operated on. Other regular medical visits are considered .