Hip fractures are like any other broken bone in the body, but they are also distinctive. Such injuries can result in the inability to walk and lead to major functional disruptions. Fractures of the hip occur often in the elderly, a population that is prone to these fractures. Such reasons make hip fractures a commonly discussed condition.
The following is an overview of how these fractures occur and how they are managed.
Relevant Anatomy of the Hip
The hip joint consists of the femur, or thigh bone, and the pelvis. The head of the femur fits into the acetabulum, a round socket in the pelvis. The femoral head comes out of a narrow femoral neck, and below the neck are two bony prominences called the greater trochanter and lesser trochanter. These anatomic landmarks comprise the upper portion of the femur involved in hip fractures.
The blood circulation to the upper femur is also noteworthy. Of three arteries that carry blood to this region, about 90% of circulation comes from the lateral epiphyseal artery. Despite being a main vascular source, this artery carries more blood to specific areas of the femur than others, a characteristic that may worsen some hip fractures.
Types and Causes of Hip Fractures
Hip fractures involve the upper femur in one of three places: the femoral neck (femoral neck fractures), through the greater and lesser trochanters (intertrochanteric fractures), and below the greater and lesser trochanters (subtrochanteric fractures). They often occur secondary to trauma, which can involve high-energy impact but may also occur with falls and minor injuries in people with more brittle bones. Factors that may weaken the femur and make it susceptible to injury include but are not limited to age, osteoporosis, inactivity of thigh muscles, and deficiency in calcium and/or vitamin D.
Treatment of Hip Fractures
After evaluation of a hip fracture by x-ray, an orthopedic surgeon decides whether surgical correction of the fracture is appropriate. He or she takes several things into account, mainly the features of the hip fracture and the overall surgical risk of the patient. If operative treatment is planned, the surgeon performs a hip arthroplasty, repairing the femur using screws, plates, and other fixating devices.
As counterintuitive as it sounds, not all patients with hip fractures are treated surgically. Such patients are of high operative risk with multiple comorbid conditions, have hip fractures that are relatively minor in severity, or have insufficient bone mass for orthopedic fixating devices to function appropriately. Certain patients may be given a walker or cane for ambulation, provided that they bear as little weight as possible on the injured leg.
