Hip Fracture

A hip fracture is a break or fracture in the upper portion of the thigh bone called the femur. The hip fracture risk increases with age. Most cases of hip fracture occur in patients of older age because the bone becomes weak with age and they are prone to traumatic and mechanical damage. It may be due to several factors like weakened eyesight, problems with the body balance and the use of multiple medicines. If the hip fracture occurs in a young patient, then it means that it is caused by high-energy events like an accident or heavy fall from a ladder or vehicle. Hip fractures are divided into three types depending upon the location of the fracture on thigh bones. These are:

1. Intertrochanteric fractures
2. Femoral neck fractures
3. Subtrochanteric fractures

The signs and symptoms of the hip fracture may include:-

1. Presence of severe pain in hip and groin region.
2. One of the legs may appear shorter than the other. Especially the leg on the injured side is shorter.
3. Unable to walk or stand. Some patients can walk but may feel extreme pain during the motion.
4. You may also have some bruises on the hip.
5. The hip might look like it is not in position or twisted.
6. The leg seems to be turned outside on the side of the fracture.
7. There may be swelling around the injured hip.

The hip fracture can be caused by any of the incidents that lead to mechanical damage to the bone of the hip. Some of the fractures may include:-

1. Car crash. (can cause a fracture in people of all age groups)
2. Falling from the standing height. (most common in older people)
3. Stress fracture. (especially in the case of athletes of long or high jump)
4. People with osteoporosis can fracture their hip while doing regular daily activities like sitting, walking, or getting out of chairs.

Some of the factors that increase the risk of the hip fracture are:-

1. Age and sex: Bone density decreases with age and becomes weak and vulnerable to breaks. Old people with vision problems and poor body balance tend to fall more than normal people.
2. People suffering from osteoporosis have weak bones and are more prone to breaks and fractures on falls and any other mechanical trauma.
3. Lack of exercise
4. Presence of medical conditions like dementia
5. Smoking
6. Low body weight
7. Parkinson's disease and stroke that causes loss of balance
8. Intestinal disease that reduces absorption of vitamin D resulting in brittle bones
9. Certain medications, such as antidepressants, increase risk of fall by causing dizziness as their side effect.

The doctor may diagnose the hip fracture by examining the patient physically, or the doctor can also use the imaging tests for a better diagnosis of the hip fracture.

1. Imaging tests
   1. X-ray: Electromagnetic beam is used to obtain a picture of the internal muscles, bones and organs on a thin film.
   2. CT scan: This uses an x-ray and a computer to produce a detailed image of the body organs, tissues, and muscles. 
   3. MRI: This setup has a large magnet, electromagnetic waves and a computer. It provides detailed images of the organs and the internal structures of the body.
2. Physical examination: You will be examined by an orthopaedic surgeon. He will notice the following to ensure the hip fracture. Firstly he will check for the history of the injury and ensure that there are no other fractures in the body. The leg on the injured side appears to be shorter than the other leg. Also, the appearance of the leg may seem to be twisted or rotated. The doctor will also check for the presence of the sensation in the affected region of the leg. Finally, it is done to check any loss of sensation in the affected part of the hip or leg.

The hip fracture treatment includes a combination of the approaches like surgery, medicines, and rehabilitation. This combined help in preventing the formation of the clots in the affected area. 

Surgical approach:

1. Internal repair using the screw: Metal screws are inserted into the bones to hold the bones together until the fracture heals. In some cases, the metal screws are attached to the metal plate that is placed at the femur (thighbone). These metal plates and the screws are removed once the bones are joined completely.
2. Total hip replacement: The upper part of the thigh bone (femur) and the socket of the pelvic bone is replaced by the artificial parts. Recent studies have revealed that total hip replacement surgery is more convenient and gives better results than other surgery. 
3. Partial hip replacement: In some cases, there is no need to replace the socket of the hip. So, in such cases, the doctors prescribed the partial replacement of the hip. 

Rehabilitation:

1. Rehabilitation is needed after the completion of the surgery. It is important to regain the full range of motion.
2. This physical therapy will focus on increasing the range of motion and increasing the strength of the muscles.
3. During the physical training session, the therapist will teach you the methods that will help the patient be independent in daily life, like using a toilet seat and dressing etc. 

You should visit an orthopaedic surgeon if the symptoms of the hip fracture become worse.

1. If you are unable to get up and walk
2. If the pain in the hip region radiates to the other parts and increases
3. If you have a persistent fever. It may be due to the infection caused by the fracture.

Some of the possible complications of the hip fracture may include:-

1. Blood clots in veins. (This usually occurs in the legs, and if it breaks, then it can travel to the lungs)
2. Pneumonia
3. Bedsores
4. Muscle atrophy
5. Infections after the surgery
6. The improper joining of the bones