Fractures around the hip joint are by far the most common I see in my fracture clinic. They cause patients significant disability and loss of independence. The treatment of these breaks, however, has been revolutionised in the last decades.
Fracture of the hip joint is a serious injury among the geriatric population. Studies show that 33 per cent of patients who suffer this fracture pass away within a year. This high mortality rate probably reflects the fact that this fracture occurs in patients who already have poor medical and physical health. This may be associated with poor vision and mobility problems.
Elderly patients, usually having osteoporosis, commonly suffer hip fractures even after low-energy, low-impact types of falls. After a fall the patient is usually unable to stand or walk and has severe pain in the groin.
Osteoporosis is a progressive loss in bone mass and its incidence increases in old age. This condition mostly affects the hip and lower back and is why these two areas are targeted when bone mass is calculated in a bone density test. Osteoporosis most commonly affects women and hence hip fractures are more common among this sex.
The elderly patient who suffers from a hip fracture typically has significant underlying medical problems
Although much more common in old age, these fractures also rarely occur in young patients but usually in the context of high-energy impacts such as road traffic accidents and falls from heights.
The elderly patient who suffers a hip fracture typically has significant underlying medical problems such as heart or lung conditions, and this increases the risk of the patient dying.
In view of this, these patients are best managed by a team involving an orthopaedic surgeon, physician, physiotherapist, dietician and occupational therapist.
Until a few decades ago, patients with fractures around the hip were treated with bed rest and traction for several weeks until the fracture healed. However, many of these patients ended up succumbing to the risks of a long period of bed rest before the fracture would have healed.
The risks associated with extended bed rest include chest infections, lung and leg clots, infected ulcers and weak muscles.
The philosophy around treating these fractures has thus changed, with patients being operated upon within 36 hours of hospital admission to achieve the best outcomes and decrease the risk of complications of bed rest.
Operations for this type of fracture vary depending on the way the hip breaks. If the break is such that the bones will heal, then they may be fixed with a plate and screws. If, on the other hand, the break affects the blood supply to the hip in such a way that the bones will not heal, then a full or half hip replacement will be required.
The patient would then usually require several weeks of exercise and physiotherapy to allow them to mobilise safely.
Unfortunately, even patients who do make it through the operation frequently lose their mobility and independence and may end up having to use sticks or frames.
Elderly people should be careful to avoid falls by removing home hazards, doing regular exercise and using a stick to aid balance if required.
Nowadays, padded hip protectors are being used by elderly patients to decrease the risk of fracture after a fall.
Alistair Melvyn Pace, consultant orthopaedic surgeon