Treatment for hip fracture often involves a combination of surgery, rehabilitation and medication.
The type of surgery you have generally depends on the location of the fracture in the bone, the severity of the fracture and your age. Surgical options may include:
- Repair with hardware. Surgeons may insert metal screws into the bone to hold it together while the fracture heals. In some cases, screws are attached to a metal plate that runs down alongside the femur. Another option is to insert a rod, known as a nail, into the marrow part of the thigh bone. A screw then passes through the upper part of the rod, through the femoral neck and into the ball portion of the hip joint.
- Replace part of the femur. If the ends of the broken bone aren't properly aligned or they've been damaged, your doctor may remove the head and neck of the femur and install a metal replacement (prosthesis). This procedure is called a partial hip replacement.
- Replace the entire hip joint. A total hip replacement involves replacing your upper femur and the socket in your pelvic bone with artificial parts called prostheses. Total hip replacement may be a good option if arthritis or a prior injury has damaged your joint, affecting its function even before the fracture.
If the blood supply to the ball part of your hip joint is damaged during a hip fracture, the bone is less likely to heal properly. This occurs most often in older people who have femoral neck fractures, so doctors may recommend partial or total hip replacement for these types of injuries.
Your care team will probably get you out of bed and moving on the first day after surgery. Physical therapy will initially focus on range of motion and strengthening exercises. Depending on the type of surgery you had and whether you have assistance at home, you may need to go from the hospital to an extended care facility.
In extended care and at home, you may work with an occupational therapist to learn techniques for independence in daily life, such as using the toilet, bathing, dressing and cooking. Your occupational therapist will determine if a walker or wheelchair may help you regain mobility and independence.
Bone density-enhancing medications called bisphosphonates may help reduce the risk of a second hip fracture. Most of these drugs are taken orally and are associated with side effects that may be difficult to tolerate, including nausea, abdominal pain and inflammation of the esophagus. If this is a problem, you may want to take a type of bisphosphonate delivered via intravenous (IV) tubing.
Long-term bisphosphonate therapy has been linked to a rare problem in which the upper thighbone cracks, but doesn't usually break completely. Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition occurring after a tooth extraction in which a section of jawbone dies and deteriorates.
Mar. 22, 2012
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- Fiechtl JF, et al. Femur and hip. In: Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-05472-0..X0001-1--TOP&isbn=978-0-323-05472-0&uniqId=230100505-57. Accessed Jan. 18, 2012.
- Burroughs KE, et al. Hip fractures in adults. http://www.uptodate.com/home/index.html. Accessed Jan. 18, 2012.
- Hip fractures among older adults. Centers for Disease Control and Prevention. http://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html. Accessed Jan. 18, 2012.
- Hip fractures. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00392. Accessed Jan. 18, 2012.
- Lewiecki EM. Prevention of osteoporosis. http://www.uptodate.com/home/index.html. Accessed Jan. 19, 2012.
- Morrison RS, et al. Medical consultation for patients with hip fracture. http://www.uptodate.com/home/index.html. Accessed Jan. 19, 2012.
- Rosen HN. Bisphosphonates in the management of osteoporosis in postmenopausal women. http://www.uptodate.com/home/index.html. Accessed Jan. 19, 2012.
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