HIP FRACTURE (Femoral Neck Fracture)

General Information

DEFINITION--A complete or partial break in the femur, the major bone in the hip joint. More than 200,000 hip fractures occur every year, and about 50% of those occur in people age 80 or over.

BODY PARTS INVOLVED--Femur, including muscles and tendons that attach the head of the femur to the acetabulum (hip socket in the bony pelvis).

SEX OR AGE MOST AFFECTED

• Breaks from common injuries affect both sexes and all ages.
• Spontaneous breaks or breaks from minor injuries affect mostly older people.

SIGNS & SYMPTOMS

• Intolerable pain when trying to walk.
• Swelling, tenderness and bruising in the hip.
• Deformed hip appearance.
• Shock from internal bleeding.

CAUSES

• Injury, especially falls and auto accidents.
• Spontaneous in pathologic conditions.

RISK INCREASES WITH

• Osteoporosis, especially postmenopausal osteoporosis.
• Bone cancer.
• Multiple medications which reduce alertness.
• Osteogenesis imperfecta (inherited condition in which bones are brittle and easily broken).
• Calcium imbalance.
• Poor nutrition, especially insufficient calcium and protein.
• Brain disorders.
• Activities that increase the risk of injury.

HOW TO PREVENT

• Ensure an adequate calcium intake (1000 mg to 1500 mg a day) with milk and milk products or calcium supplements.
• Protect against falls, especially in the home.
• Women should consider taking estrogen after menopause. Consult your doctor.
• Use cane or walker if you feel unsteady.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• X-rays of the hip.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Surgery is the recommended treatment. (See Hip Nailing for Hip fracture in Surgery section.)
• Traction may rarely be used.
• Physical therapy and rehabilitation.

POSSIBLE COMPLICATIONS

• Surgical-wound infection.
• Nerve and blood-vessel damage at the fracture site.
• Osteoarthritis.
• Inadequate blood supply to the injured area, causing tissue death of the bone.
• Poor healing (non-union) of the fracture.
• Blood clots due to bed confinement.
• Following surgery, older persons sometimes have a period of mental deterioration which usually subsides.

PROBABLE OUTCOME--In most patients, the condition is curable with surgery and rehabilitation.

How To Treat

GENERAL MEASURES--

• After surgery, you will be up as soon as possible (usually the next day).
• Occasionally, the complications after the first surgery may require the need for further surgery, such as hip joint replacement.

MEDICATION--Your doctor may prescribe:

• Pain relievers as needed.
• Antibiotics to fight infection, if necessary.
• Stool softeners to prevent constipation.
• Estrogen replacement therapy and calcium supplements to help retard more bone loss.

ACTIVITY--

• After awakening from anesthesia, move the unaffected leg often to decrease the possibility of deep-vein blood clots.
• Physical therapy and rehabilitation will be started as soon as you are able. You will start by using a walker with someone nearby.

DIET--Clear liquids for the 1st day after surgery, then no special diet. Ask your doctor if you should take calcium supplements.

Call Your Doctor If

• You have symptoms of a hip fracture. Call immediately if you have numbness or loss of feeling below the fracture site. This is an emergency!
• The following occurs after surgery: Swelling above or below the fracture site. Chills, fever, muscle aches or headache. Increased pain, swelling, redness or discharge at the surgical site. Constipation.