Hip Fractures

Hip fractures occur as a result of a fall or direct blow to the side of the hip. Osteoporosis, osteopenia, cancer and other medical problems can make the hip prone to breaking. There were approximately 300,000 hip fractures in the USA in 2011. It is expected that there will be almost double that number over the next 20 years. The lifetime risk of hip fracture in women is 1 in 6.

Symptoms

Pain in the groin or at the upper thigh and hip are common. There is pain with any movement of the leg or hip. There may be groin pain before the break occurs in some people with a stress injury or cancer. It is most common that the leg is short and rotated. In order to decide what is wrong with your hip and how best to treat it, the following tests may be performed as needed:

• X-ray of the hip (to see the type of fracture and the best way of treating it)
• X-ray of your chest (to check for any heart or lung problem)
• ECG (Heart tracing)
• Blood tests

These tests help determine if you need an operation, and if so, which type of operation. You will be kept as comfortable as possible with painkillers, a nerve block and/or other medication. If you have fractured your hip, an orthopaedic surgeon will be consulted.

Physician Examination

After a visual and physical examination of the affected hip and leg, an X-ray is performed to evaluate the hip and femur. In some cases, if there is hip pain and uncertainty about a broken hip, an MRI, CT, or bone scan may be performed at the discretion of the physician to find an unseen fracture on X-ray.

Once admitted, you will have an assessment to determine your general health and fitness for an operation. This may include more tests. The surgery to fix a broken hip should be performed as soon as it is safe for optimal outcome.

You will be taken to the operating room to have your hip repaired. The benefits of the operation are to reduce the pain and allow you to walk again on your leg as soon as possible. As with all surgery there are potential risks and complications.

Hip Fracture Surgical Treatment

Hip fracture is a generic term commonly used to describe fractures around the hip. This includes femoral neck, pertrochanteric (intertrochanteric) and subtrochanteric fractures. Femoral neck fractures are treated with either hip replacement or fixation, depending on fracture pattern, displacement and patient age. Pertrochanteric and subtrochantericare treated with reduction and fixation.

Half of all fractures around the hip area are pertrochanteric fractures. This fracture is through the trochanteric region of the femur (your upper thigh bone) and needs repair more often than replacement. The trochanter is an anatomical part of the femur that you can feel in your upper outer thigh and is connected to your hip bone.

Femoral neck fracture

Intertrochanteric fracture

Subtrochanteric fracture

The most common way to repair a pertrochanteric fracture is with the use of a trochanteric entry intramedullary nail. The nail is a metal rod (usually titanium alloy) that is an elongated cylindrical cannulated device fashioned to fit within the intramedullary cavity of the femur through an opening made at the top of the greater trochanter. A lag screw is then placed through the nail and into the neck and head of the femur to fix the angle between the head, neck and shaft of the femur. There are several challenges that can occur because of the complexity of these fractures – the EPIX VAN System solves these issues.

Because of the difficulty of these fractures, the hip can be fixed in a horizontal position, called varus, 10-12% of the time, causing a short leg and limp. The position of the lag screw within the head of the femur also needs to be in an optimal position in order to keep the hardware from cutting out of the weak bone. The patented EPIX VAN System may help the surgeon to get the lag screw in the optimal position and the hip out of a varus position. EPIX VAN is the only variable angle nail that corrects hip malalignment and places the implant perfectly every time.

Goals After Surgery

• Early mobilization out of bed
• Muscle strengthening & flexibility,
• Learning how to walk