Why Choose Cedars-Sinai Marina del Rey Hospital for Hip Fracture Treatment?
Hip fractures are relatively common in adults, they affect over 300,000 people in the United States each year and often lead to devastating consequences. Persistent pain and limited physical mobility from a hip fracture frequently lead to disability. The highly skilled specialists, such as surgeons, at Cedars Sinai Marina del Rey Hospital can provide multiple surgical and non-surgical treatment options for hip fractures.
A hip fracture is a break in the upper quarter of the thighbone - also known as femur - of your hip joint. The thighbone can sustain either a single break or multiple breaks.
A hip fracture can be very painful and needs immediate medical attention. Some hip fractures are more serious than others and can have life-threatening complications.
Most hip fractures occur in patients 65 years or older who are injured in household or community falls. Hip fractures can be prevented by taking steps to avoid falls and maintain bone density.
Hip Fracture Surgical Procedures Performed at Cedars Sinai Marina del Rey Hospital
Treatment for a hip fracture depends upon the type and location of the fracture, and your age and condition.
Management of most hip fractures requires surgical repair or replacement within 1 to 2 days of the injury, followed by physical therapy. The goal is to relieve the acute pain of the fracture, allow you to get out of bed, enable you to resume your normal activity level, and lessen the risk of complications.
Only a small group of non-displaced fractures in healthy patients can be treated without surgery. Conversely, a separate small group of patients may be too sick to have surgery safely.
If you are admitted to the hospital with a hip fracture, you will have preoperative testing and will most likely be seen by an internist who will make sure that you are medically ready to have surgery. This process of getting you medically ready for surgery is called optimization.
Sometimes, you may need to be seen by a specialist, such as a cardiologist or a pulmonologist, to treat specific medical problems. If you have been on a blood thinner, it may be necessary to wait for your clotting times to improve.
Ideally, the surgery should be done within 48 hours, but sometimes it may take longer. Even if it takes longer, it is better to be optimized than to rush to surgery.
To strengthen and stabilize your joint, your surgeon may use metal devices or do a partial or total hip replacement.
Physical Therapy for Hip Fracture
Hip surgery usually requires an in-hospital stay. While in the hospital, you will do physical therapy exercises to regain strength and range of motion in your hip.
Getting you out of bed as soon as possible will help prevent medical complications such as bedsores, blood clots, and pneumonia. Prolonged bed rest can also lead to disorientation, especially in very old patients, making recovery and rehabilitation much more difficult.
You will continue physical therapy at home or in a rehabilitation facility.
Medication Needed for Hip Fracture
Hip fractures are classified by:
- The specific area of the break. A hip fracture can cause injury to one of the following areas of the upper femur:
- Femoral head. The hip is a ball-and-socket joint. The head is the ball of the femur that sits in the socket, part of the pelvis bone. Femoral head fractures are usually the result of a high-velocity event and are extremely rare.
- Femoral neck. The neck is the area of the femur below the ball, 1 to 2 inches from your hip joint. Most hip fractures fall in relatively equal numbers into the categories of the femoral neck and intertrochanteric fractures. These intracapsular fractures are commonly seen in older adults, but rare among younger patients. Often, they are related to osteoporosis or osteomalacia. These fractures usually result from minor trauma, with falls accounting for 90% or torsion. They may cause complications because the break usually cuts off the blood supply to the head of the thighbone. You may have severe pain and lie with the extremity slightly shortened, abducted, and externally rotated.
- Trochanteric fracture. A fracture in the greater trochanteric area will cause you pain, especially with abduction and extension. A fracture in the lesser trochanteric area will cause you pain during flexion and internal rotation.
- Intertrochanteric fracture. This is one of the most common fractures, occurs generally in elderly patients and women, and is related to osteoporosis. This type of fracture affects the area below the neck of the femur and above the shaft of the femur, 3 to 4 inches from your hip joint. It rarely interrupts the blood supply to your bone and may be easier to repair. You may note pain, hip edema, ecchymosis, and pain with any movement.
- Subtrochanteric fracture. This is a fracture in the upper part of the shaft of the femur, below the greater and lesser trochanters.
- The fracture's relation to the hip capsule:
- Intracapsular fractures. This refers to the fractures of the head and neck. Frequently, their healing is complicated.
- Extracapsular fractures. The fractures in trochanteric, intertrochanteric and subtrochanteric areas are extracapsular.
- The degree of displacement.
- In a displaced fracture, the bone cracks into two or more parts and moves out of alignment. Higher-grade displacement comes with a worse prognosis.
- In a non-displaced fracture, the bone cracks but does not move out of alignment.
Stress fracture of the hip is another type of fracture that may be harder to diagnose. It can be caused by overuse and repetitive motions and can be confused with muscle strain or tendonitis. A stress fracture is a hairline crack that may not involve the whole bone.
The treatment and prognosis for successful union and restoration of normal function vary considerably with fracture type.
Symptoms of Hip Fracture
An elderly patient who suffered a fall and a hip fracture typically will complain of:
Young athletes who suffered non-displaced stress fractures may be ambulatory and may complain of pain in the hip or knee.
Symptoms of a hip fracture may also include:
Hip fracture symptoms may actually come from other medical conditions, so always see your healthcare provider for a diagnosis.
Diagnosis of a Hip Fracture
Besides a complete medical history and physical exam, diagnostic procedures may include laboratory studies to determine your medical condition and to allow correction of any abnormalities before surgery. The laboratory studies ordered based on your presentation and the potential for surgery may include:
Diagnostic procedures for hip fracture may also include the following:
- X-ray. A chest X-ray film and an electrocardiogram (ECG) may be used to further assess your medical condition before any surgical intervention. X-ray films help determine which type of fracture, if any, is present.
- CT scan. These are more detailed than the standard X-rays.
- MRI. Can be useful in defining otherwise imperceptible fractures if the clinical picture suggests a fracture or stress fracture, and the X-ray findings cannot demonstrate it.
Risk Factors for Hip Fracture
Factors that can increase your risk for hip fracture include the following:
- Osteoporosis. Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis (loss of bone tissue.) Over 1.5 million Americans have fractures each year because of loss of bone tissue.
- Older age. The risk of hip fracture rises with age, doubling for each decade after age 50. Most hip fractures in older people happen because of falling while walking on a level surface, often at home.
- Race. Caucasians and Asians are more likely to be affected by osteoporosis than others.
- Gender. Women are more prone than men to osteoporosis. If you are a woman, you lose 30% to 50% of your bone density as you age. After menopause, you make less estrogen that has an important role in maintaining bone strength and density.
- Previous hip fracture
- Previous Colles or a vertebral fracture related to osteoporosis
- Maternal history of hip fracture
- Vision problems
- Balance problems, dizziness, decreasing depth perception
- Neurological impairment
- Thinking problems, such as dementia
- Generalized cardiovascular disease or heart failure
- Cigarette smoking
- Alcohol abuse
- Lack of physical activity
- Tall stature
- Low body weight
- Poor nutrition, including a diet low on vitamin D and calcium
- Physical problems such as weakness, disability, or unsteady gait, decreased mobility
- Institutional living, especially correlated with antipsychotic medications
- Prolonged corticosteroid use
- Use of medicines that cause bone loss, including furosemide, thyroid hormone, phenobarbital, and phenytoin
- Use of protease inhibitor therapy by HIV-positive patients
If you are an athlete, factors that can predispose you to the development of stress fractures include the following:
Depending on your specific health condition, there may be other risks. Discuss any concerns or questions with your doctor.
Causes of Hip Fracture
A hip fracture can happen for many reasons and in many ways:
- A fall — especially one to the side — is the most common reason for a hip fracture among the elderly.
- A few people may suffer a hip fracture spontaneously.
- If you are a younger person, your hip fracture is typically the result of:
- A high-energy event, such as falls from significant heights or vehicle collision. Compared to minor trauma injuries, high-velocity injuries are more difficult to treat and are associated with more complications.
- Significant trauma during athletic activity
- An underlying disease process may be another cause of fracture, such as:
At least two complementary and alternative medicine practices are used with hip fracture patients:
- Acupressure. According to traditional Chinese acupuncture, auricular acupressure involves stimulating acupuncture points by placing tiny beads onto the outer ear at such points. Bilateral auricular acupressure can be performed at relaxation points known to decrease pain and anxiety. Using these points, body areas can be stimulated to direct energy flow.
- The Jacobson relaxation technique. This involves a two-step process of contracting and relaxing muscles. With practice, you learn which specific muscles are related to pain and you relax them.
Alternative hi fraction treatments may be combined with our physician's care only to help relieve your signs and symptoms as these methods do not provide a complete treatment.
Preventive measures may include:
- Taking medicines to prevent bone loss, as prescribed by your healthcare provider. Most people are not aware they have osteoporosis until they have a fracture.
- Having a bone density test, if you are a woman at menopause. This measures your bone mineral content and the thickness of your bone, which can indicate decreased bone mass.
- Doing non-work-related physical activity. For example, walking, jogging, hiking, or regular weight-bearing exercise. Exercise programs such as Tai Chi can help increase strength and balance.
- Increasing your BMI
- Eating foods rich in vitamin D and calcium
- Stopping smoking
- Controlling your alcohol intake
- Keeping objects off the floors or stairs to prevent falls
- Installing grab bars in the tub and using slip-resistant rugs next to the bathtub
- Placing night lights from the bedroom to the bathroom
- Using nonskid backing or rug pads to keep rugs in place
- Using steady furniture or step ladders
- Visiting an ophthalmologist every year to have your vision checked and vision loss treated