injuries and poisoning
Hip Fractures
Treatment of Hip Fractures
Usually surgery to repair or replace the hip Rehabilitation Usually, treatment of a hip fracture consists of surgery because it shortens the time people have to stay in bed and reduces the risk of the serious problems that bed rest can cause. Surgery enables people to get out of bed and begin walking as soon as possible. Usually, people can take a few steps with a walker 1 to 2 days after the operation. Rehabilitation After a Hip Fracture (physical therapy) is started as soon as possible after treatment of a hip fracture. Surgery is the preferred treatment for hip fractures because it enables people to walk sooner and avoid serious problems that can result from staying in bed for a long time. Fractured hips may be surgically repaired or replaced. The procedure used for repair is called Surgery (ORIF). The hip is repaired if the fracture is not too severe. The hip may be replaced (called arthroplasty) when the fracture is severe or when the blood supply to the head of the thighbone has been disrupted. While waiting for hip surgery in the emergency department, older people may be in pain. To help control the pain, doctors may inject an anesthetic into a nerve in the hip. This procedure (called a nerve block) prevents the nerves from sending pain signals to the brain. Femoral neck hip fracturesmay be repaired by inserting metal pins through the neck and into the head of the thighbone. Intertrochanteric hip fracturescan be repaired by attaching a sliding compression screw and metal side plate, which holds the bone fragments in their normal position while the fracture heals. This repair is usually strong enough to enable people to stand and put their weight on the affected leg shortly after surgery. Although the bone usually heals in a couple of months, most people need at least 6 months before they feel as comfortable and strong and can walk as they did before the fracture. However, increasingly, hip fractures are being treated with intramedullary screws (a type of screw used to stabilize the bone) or total hip replacement. Hip joints are repaired when the fracture is not too severe. How the repair is done depends on where the thighbone (femur) is fractured: Femoral neck (subcapital) fractures:These fractures occur in the neck of the thighbone. Metal pins can be inserted to support the femoral head. Intertrochanteric fractures:These fractures occur in the large bumps of bone (trochanters) below the neck of the thighbone. For these fractures, a sliding compression screw and a metal side plate may be used. Other treatments, such as hip replacement, may be used depending on the person's condition. Hip repair preserves the person’s own hip joint. Part or all of the hip joint may be replaced. Before replacing the joint, doctors remove the broken pieces of bone. Ifpartial hip replacement(hemiarthroplasty) is needed, doctors use a ball-shaped metal part (prosthesis) designed to fit into the joint socket in the pelvic bone. The prosthesis has a strong stem that fits within the center of the thighbone. Some prostheses are secured to the bone with a plastic cement that sets rapidly. Other prostheses have special porous or ceramic coatings that the surrounding living bone can bond to directly. Older people who walk very little and thus put little stress on the hip joint are usually treated with partial hip replacement. Total hip replacement(total hip arthroplasty) is sometimes needed—for example, when a femoral neck fracture is likely to disrupt the hip's blood supply. Total hip replacement has greater risks than partial hip replacement. But because it results in better function, it is being increasingly used in older people who are active. For total hip replacement, the femoral head and the surface of the socket are replaced. After most hip replacement operations, people usually begin walking with crutches or a walker 1 to 2 days after the operation, and they switch to a cane in 6 weeks. Artificial joints do not last forever. People, especially if they are active or heavy, may need to have another operation 10 to 20 years later. Joint replacement is often a good choice for older people because they are less likely to need another operation. Also, older people benefit greatly from being able to walk almost immediately after surgery. Part or all of the hip joint may be replaced: Partial hip replacement (hemiarthroplasty):When the top (head) of the thighbone (femur) is badly damaged, it may be replaced with an artificial part (prosthesis), made of metal. Total hip replacement (total hip arthroplasty):Sometimes the surface of the socket into which the head of the thighbone fits (forming the hip joint) must also be replaced. The socket is replaced with a metal shell lined with durable plastic. 