Hip fractures occur in the neck of the femur (thighbone), about 1 to 2 inches from the joint or in the protrusion of the femur known as the trochanter, about 3 to 4 inches from the joint. Surgery is typically required to reposition the hipbone.
Femoral neck fractures are generally repaired in one of three ways. In a procedure known as internal fixation, metal screws are inserted into the bone to hold it together while it heals. In hemiarthroplasty, the head and neck of the femur are replaced with a metal prosthesis. Total hip replacement involves replacing the upper femur and socket with a prosthesis.
Surgeons repair fractures in the trochanter by inserting a compression hip screw across the bone and attaching it to a metal plate that runs down the femur. Older patients are more likely to undergo hemiarthroplasty or total hip replacement. A person who is too ill to undergo surgery may instead be placed in traction to allow the fracture to heal, but traction is a last resort because staying immobile increases the risk of blood clots.
Some complications of hip fractures include infection, deep vein thrombosis (blood clotting in the deep veins of the leg), pulmonary embolism (a blood clot that travels to the lung), pneumonia, and pressure ulcers (breaks in the skin that can become infected). Many of these complications result from bed rest and inactivity after surgery. Medications for pain control can lead to disorientation and confusion. Complications become more serious with other factors, such as older age, and the presence of other health problems.
Rehabilitation after hip fracture is essential for regaining the ability to walk and live independently. Most people who lived independently before the hip fracture will require home care and assistance. About half will require canes or walkers for several months after surgery, and nearly half of this group will need a cane or walker to move around the house or outdoors for the rest of their lives.
Treatment of Other Osteoporotic Fractures
Osteoporosis can lead to a fracture at any site in the body. The most common sites after the spine and hip are the wrists, ribs, toes, and collarbone. Treatment depends on the bone that is broken and whether or not it is displaced. Some fractures (such as wrist fractures) require a cast, while others (such as toe fractures) do not. As with all osteoporosis-related fractures, treatment focuses on relieving pain, maintaining function and mobility, treating the underlying osteoporosis, and preventing future falls.