Repair of Hip Fracture

What is a hip fracture repair?

A hip fracture repair is a type of surgery to fix a broken (fractured) hip. Another name for this is internal fixation. Hip fracture repair uses screws, nails, or plates to help hold broken bones together so they can heal correctly.

Your thighbone (femur) meets with your pelvis at your hip joint. This joint is called a ball-and-socket joint. The socket is a cup-shaped structure on your pelvis called the acetabulum. The ball, or head, is the rounded upper end of your femur. Cushions of tough flexible tissue (cartilage) protect the inside of the acetabulum and the surface of the head. A fluid-filled capsule surrounds the joint. A neck connects the head of your femur to its long shaft. At the top of the shaft, just before the neck, is a bump called the greater trochanter. A smaller bump, called the lesser trochanter, sticks out from the underside of the area where the shaft and neck meet.

A hip fracture is a break in the upper part of your thighbone. It may include the top of the shaft, the neck, or the head.

During your hip fracture repair, your surgeon will make a cut (incision) in your skin to reach the broken bone and put the pieces back in place. Once your surgeon has put the pieces back in the right place, they will use screws, nails, or plates to hold them together.

Why might I need a hip fracture repair?

You might need a hip fracture repair if you have had a broken hip. Hip fractures often must be fixed with surgery. Depending on the type and complexity of your break, as well as your health, you may need either a hip replacement or a hip fracture repair.

In general, if you have a break that affects the head and neck of the femur (intracapsular fractures), you are likely a good candidate for hip replacement or fracture repair. Based on the nature of the break and how much the bone has moved out of place, the blood supply to the head of the femur may be damaged. This can lead to death of the bone in that area. The term for this is avascular necrosis. It is most common in older adults. A hip replacement can prevent problems, such as arthritis that may happen because of this.

Hip fracture repair is a treatment choice in younger adults and children. It’s also good for hip fractures that happen between the greater and lesser trochanter (intertrochanteric fractures). Other types of implants are more typical for breaks that are farther down the leg (subtrochanteric fractures).

Hip fractures often occur because of falls or some other form of blow to the hip. Health problems that raise the risk for falls include:

• Dementia

• Vision problems

• Dizziness

Conditions, such as osteoporosis, cancer, and repetitive stress injuries, also can weaken bones. That can increase your risk for hip fracture.

What are the risks of a hip fracture repair?

The goal of hip fracture repair is to put the bones back into place so they can heal the right way. It will also reduce your pain and help you to get up and move around again. As with any surgery, sometimes complications may occur. These may include:

• Infection

• Bleeding

• Blood clots

• Injury to nearby nerves

• Incorrect or incomplete healing of the femur

• Limping because of changes in leg length

• Arthritis

There is also a risk that the procedure might not get rid of your pain. Or it might cause new pain. Your own risk of complications may vary based on your age and any other health problems. Ask your healthcare provider about the risks that most apply to you.

How do I get ready for a hip fracture repair?

Your medical team can tell you how to get ready for your surgery. Before your surgery, it's important to give a history of all your health problems. Let your healthcare provider know if you have any medicine allergies. Also let them know if you have a more recent problem, such as a sudden fever. Tell them if you are pregnant or think you might be pregnant.

Discuss any medicines you may be taking. That includes over-the-counter medicines and supplements. Ask if you need to stop taking any of these before your surgery.

In some cases, your healthcare provider might want more tests before your surgery. These might include:

• X-rays, a CT scan, or an MRI. These imaging tests look at the bones of your hip and for signs of injury to nearby tissues.

• Chest X-rays and electrocardiogram. These are done to make sure your heart and lungs are normal.

• Blood tests. These check how much you have bled and to look at your body chemistry.

• Urinalysis. This is done to look for signs of infection and to cut the risk for infections after your surgery.

Follow any directions you are given for not eating or drinking before your surgery.

What happens during a hip fracture repair?

The details of your hip fracture repair surgery will depend on the nature of the injury and the way your healthcare provider will do the surgery. An orthopedic surgeon with trained assistants will do the surgery. An anesthesiologist will make sure you don't feel pain during the surgery. The surgery may take a few hours. Talk with your healthcare provider about what to expect. In general:

• You may get general anesthesia so you can sleep through the surgery. If you get regional or local anesthesia, you may also get medicine to make you feel relaxed and sleepy.

• Your heart rate, blood pressure, and other vital signs will be carefully watched before, during, and after the surgery.

• You may get antibiotics to help prevent infection.

• The surgeon makes a cut (incision) over the outside of your hip, cutting through your skin and muscle.

• If the bone fragments are not lined up correctly (displaced), the surgeon will line them up. This step is called a reduction.

• The surgeon may place a plate or nail alongside the bone fragments.

• The surgeon uses screws to attach the bone fragments together. If the surgeon is using a plate or nail, they will use screws to attach the plate to the fragments.

• The surgeon or an assistant will close up your skin.

What happens after a hip fracture repair?

After your surgery, you will go to a room to be watched while your anesthesia wears off. You will get medicine to ease pain. You may get medicine for nausea if needed.

After your initial recovery, you will go to your hospital room. You should be able to start eating and drinking again slowly. You may need to wear stockings or plastic devices to help prevent blood pooling in your legs. You may need to take medicine to prevent blood clots. You may be taught how to do breathing exercises and coughing to help prevent pneumonia.

Your surgeon may decide to get an X-ray or another imaging study to look at your hip. You may also need tests to check your blood or urine.

You may notice some drainage from your incision for the first few days. Tell your healthcare provider right away if you have:

• Increased redness

• Swelling

• Drainage

• High fever

• Severe pain or pain that doesn't get better

Your surgeon will tell you when to start moving around and how much weight to put on your leg. They may direct you to not put your full weight on your leg at first. You may stay in the hospital for a few days up to a week or so while your hip starts to heal. Depending on how you do, you may be able to go home. Or you may need to go to a rehabilitation or nursing facility.

Your surgeon may give you directions on what types of activities you can and can’t do. As you start to get around, you may find that you need to use a cane or crutches. You may also need to work with a physical therapist to regain your mobility and strength.

You should be able to do light activities in a few weeks. During this time, it may be helpful to have extra help.

Keep all your follow-up appointments. Follow all your surgeon’s directions. If you have external stitches or staples, they will be removed a week or so after your surgery.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results. Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure