Hip Fracture Treatment Options: Surgical and Non-Surgical Approaches

Hip fractures demand urgent intervention to restore function and prevent complications. The most common treatments include surgical repair with metal hardware or partial to full hip replacement, depending on the fracture type and damage to the blood supply. Non-surgical options like physical therapy and pain management may be used when surgery is not suitable.

Different fractures require different approaches. For instance, intertrochanteric fractures are often repaired with specialized screws and plates (e.g., sliding hip screws or intramedullary nails), while others may require prosthetic implants. The choice of treatment depends on the patient’s overall health, fracture location, and severity.

This guide explores these approaches clearly and factually, providing essential information on hip fracture management.

Key Takeaways

• Hip fractures can be treated surgically or nonsurgically, depending on patient and fracture characteristics.
• Surgical options include metal screws, plates, rods, or hip joint replacements.
• Non-surgical care focuses on bone healing support and physical rehabilitation.

Understanding Hip Fractures

These fractures occur in the proximal femur (thighbone's upper portion) and present differently based on fracture type and patient factors like bone density. Most result from falls in older adults, causing acute groin pain and immediate mobility loss in the affected leg.

Types of Hip Fractures

Hip fractures are classified mainly by their location on the femur:

• Femoral neck fractures occur just below the ball of the hip joint. These fractures may disrupt the blood supply, sometimes necessitating hip replacement.
• Intertrochanteric fractures happen between the greater and lesser trochanters just below the femoral neck. These are usually stable and fixed with screws or plates.
• Subtrochanteric fractures involve the femoral shaft just below the trochanters and are often caused by high-energy trauma or weakened bones.

Displaced fractures (separated bone fragments) typically require surgical intervention, while stable fractures (aligned fragments) may heal with conservative treatment. Associated pelvic ring or acetabular fractures, though rare, indicate high-energy trauma.

Epidemiology and Risk Factors

Hip fractures mainly affect elderly patients, especially women, due to decreased bone mineral density from osteoporosis. Low bone density weakens bones, increasing fracture risk from minor trauma like falling from standing height.

Other risk factors include cancer that weakens bones, previous fractures, and certain medications. High-energy trauma can cause hip fractures in younger populations. Women are disproportionately affected because of hormonal changes affecting bone density.

As the population ages, the incidence of hip fractures is rising worldwide. Prevention focuses on managing osteoporosis and reducing fall risks.

Signs and Symptoms

Hip fracture symptoms typically include sudden hip pain, often felt in the groin or upper thigh. Pain worsens with movement or bearing weight.

Other signs are:

• Swelling or tenderness around the hip
• Inability to stand or walk
• Shortening or outward rotation of the affected leg

Patients may report a fall or injury before symptoms begin. Prompt diagnosis is critical, often confirmed with imaging, to guide treatment and prevent complications.

Diagnosis of Hip Fractures

Diagnosing a hip fracture requires careful assessment of physical signs and the use of imaging to confirm the injury. Accurate diagnosis ensures appropriate and timely treatment.

Physical Examination

The clinician begins with a detailed physical examination focused on the hip and surrounding areas. Common signs include intense pain, especially in the groin or upper thigh, which worsens with movement. The affected leg may appear shortened or externally rotated.

Tenderness and swelling near the hip joint are also typical. The patient’s ability to bear weight is tested cautiously. Limited range of motion and pain upon gentle palpation of the thighbone area help identify the fracture site.

Physical findings guide the need for further imaging and help distinguish hip fractures from soft tissue injuries or arthritis.

Imaging Techniques

X-rays are the primary imaging modality for diagnosing hip fractures and are usually the first step. Standard views include anteroposterior and lateral projections of the pelvis and hip.

Sometimes, initial X-rays do not reveal nondisplaced fractures. In such cases, magnetic resonance imaging (MRI) is preferred due to its higher sensitivity. MRI can detect fractures missed by X-rays and evaluate associated soft tissue injury.

Additional imaging, like CT scans, may be used when an MRI is unavailable or contraindicated. Imaging confirms fracture location, type, and severity—critical information for planning treatment.

Surgical Treatment Options

Surgical treatment for hip fractures aims to restore mobility and reduce pain by stabilizing or replacing damaged bone. Approaches differ based on fracture type, patient age, and bone quality. Options commonly include internal fixation to hold the bone in place or replacement of part or all of the hip joint.

Internal Fixation and Hip Pinning

Internal fixation, also called hip pinning, involves the insertion of metal screws, rods, or plates to stabilize the fractured bone. This technique is often used for fractures where the bone fragments can be aligned and held securely. It preserves the patient’s natural hip anatomy while promoting bone healing.

Dr. Mangino typically use this method for femoral neck or intertrochanteric fractures. The hardware helps maintain proper alignment during recovery. This surgery usually requires a smaller incision and may result in faster recovery times than hip replacement.

Possible risks include hardware failure or nonunion, but internal fixation remains a preferred option for younger patients or those with less severe fractures. It is important to monitor bone healing closely after surgery.

Partial Hip Replacement (Hemiarthroplasty)

Partial hip replacement, or hemiarthroplasty, replaces only the femoral head, which is the “ball” part of the joint. The damaged or fractured femoral head is removed and replaced with a prosthetic implant, while the hip socket (acetabulum) is left intact.

This approach suits patients with displaced femoral neck fractures or those with poor bone quality, where internal fixation is unlikely to succeed. It offers pain relief and allows early mobilization.

Hemiarthroplasty is less extensive than total hip replacement, generally resulting in shorter surgery time and reduced risk of dislocation. However, some patients may later require total hip replacement if socket wear develops.

Total Hip Replacement

Total hip replacement involves replacing both the femoral head and the acetabulum with prosthetic components. This option is considered when there is extensive joint damage, arthritis, or failed previous surgeries.

The procedure addresses both pain and function by providing a new, stable joint surface. It is especially beneficial for active patients who need long-term joint stability and mobility.

Surgery is more complex and requires a longer recovery time than other options. Risks include infection and dislocation, but implants today provide durable outcomes with high patient satisfaction. Total hip replacement is often recommended for displaced fractures with joint involvement or significant pre-existing joint disease.

Non-Surgical and Supportive Management

Non-surgical management prioritizes fracture stabilization, pain control, and complication prevention. Care often involves close monitoring, supportive devices, and rehabilitation to restore mobility while reducing risks related to immobility and bone health.

Non-Surgical Interventions

Non-surgical management is typically reserved for patients with high surgical risk or specific fracture types. It often includes traction to align the bone fragments and reduce pain by limiting movement. Pain medication is carefully managed to address discomfort while minimizing side effects.

Orthotic devices like braces or splints may stabilize the hip joint, promoting healing and allowing partial weight-bearing. Medical care monitors for complications such as blood clots, infections, or pressure ulcers.

Patients may receive treatment in a skilled nursing facility for close observation and care. Attention to calcium and vitamin D supplementation supports bone mineral density and helps reduce the risk of future fractures, particularly in individuals with osteoporosis.

Rehabilitation and Recovery

Rehabilitation plays a critical role in non-surgical recovery. Physical therapy aims to help patients regain strength and mobility gradually. Early mobilization under supervision reduces the risk of complications caused by prolonged bed rest, such as muscle atrophy and respiratory issues.

Exercises focus on improving balance and stability to reduce fall risk. The intensity and duration of physical therapy depend on the patient’s general condition and fracture severity. Skilled nursing facilities often provide tailored rehabilitation programs to support recovery.

Regular assessment of bone density guides ongoing treatment to strengthen bone structure and aid in healing, aiming for the best possible functional outcome.

Prevention of Future Fractures

Preventing subsequent hip fractures involves addressing both bone health and fall risk. Improving bone density through adequate intake of calcium and vitamin D is essential, alongside medications prescribed for osteoporosis when appropriate.

Fall prevention includes modifying the living environment, balance training, and strength exercises. Patients are advised to avoid hazards in their homes and use assistive devices as needed.

Monitoring for stress fractures or early signs of bone weakening is important to intervene promptly. Ongoing medical care focuses on reducing risks that could lead to repeat fractures, thereby improving long-term mobility and quality of life.

Complications and Outcomes

Hip fracture treatment carries risks that affect patients differently depending on their overall health and treatment speed. Complications can arise shortly after surgery or develop over time, impacting recovery and long-term quality of life.

Short-Term Medical Complications

After surgery, patients face risks such as pulmonary embolism, which occurs when blood clots block lung arteries. This is a critical concern requiring medication and early mobilization to prevent.

Other common medical complications include infections, cardiac events, and respiratory problems. These can increase morbidity and even mortality within the initial weeks following surgery.

Prompt rehabilitation and efforts to get patients out of bed quickly reduce risks like bedsores and blood clots. Still, serious cardiac and pulmonary issues remain major factors influencing early outcomes after repair.

Long-Term Consequences

Long-term complications often involve the hip joint itself. Avascular necrosis results from disrupted blood supply to the femoral head, potentially causing bone death and joint collapse.

Another frequent issue is hip dislocation, especially after surgical repair, which can limit mobility and require additional intervention.

Rehabilitation focuses on restoring function and minimizing these outcomes, but some patients experience persistent pain or decreased mobility. Mortality rates remain higher in the year following a hip fracture, partly due to these extended health challenges.

Frequently Asked Questions

Treatment for hip fractures varies widely depending on the fracture type, patient health, and age. Options include surgical repair, replacement, and, in select cases, non-surgical management. Recovery involves managing pain, regaining mobility, and preventing future fractures.

What are the non-surgical treatment options for hip fractures in older adults?

Non-surgical treatment is generally reserved for patients who cannot tolerate surgery due to health risks. It may involve prolonged bed rest, pain management, and physical therapy focused on gentle movement to avoid complications.

What are the different surgical procedures available for hip fractures?

Common surgical options include the use of metal screws, plates, or rods to stabilize the bone. In cases where blood supply to the hip is damaged, a partial or total hip replacement might be necessary to restore function. Surgery is often urgent to improve outcomes.

How does one's age and health status affect the choice of treatment for a hip fracture?

Older adults with multiple health conditions may face higher surgical risks, sometimes making non-surgical care more suitable. Conversely, healthier patients are more likely to benefit from surgical repair or replacement for better mobility and recovery.

What are the potential complications following hip fracture surgery?

Complications can include infection, blood clots, implant failure, and delayed bone healing. There is also a risk of reduced mobility and prolonged pain, especially in older patients or those with pre-existing conditions.

What is the recovery process like after treatment for a hip fracture?

Recovery typically involves several months of rehabilitation focused on restoring strength and mobility. Pain can last weeks but is managed with medication and exercise. Early movement and physical therapy are crucial for a successful recovery.

How can the risk of future hip fractures be reduced after initial treatment?

Prevention strategies include addressing bone health through medication, nutrition, and managing underlying conditions like osteoporosis. Balance training and home safety modifications help reduce fall risk. Ongoing exercise maintains strength and stability.