Hip fracture is considered as one of the most common problem in public health, which significantly impacts the quality of life and the cost of the health care. According to a study, published in the Springer Journal- Osteoporosis International, hip fractures incidences are expected to exceed up to 6 million in 2050 worldwide. There are two types of hip fractures, namely femoral neck fracture and intertrochanteric hip fracture. Femoral neck fracture is one of the common skeletal injuries that mostly occurs in the elderly people as a result of osteoporosis or thinning of the bone. It can also happen in the younger people under the age of 50 due to any trauma with high velocity and as a part of multiple fractures.
The femur is the strongest and longest bone in our body. The head of the femur is articulated with the pelvic bone forming the hip joint. The head of the femur is like a ball which fits into the socket of the hip joint. When the ball or the head of the femur get fractured, it is called a femoral neck fracture. The fracture creates an interruption in the blood circulation of the bone, which can lead to delayed healing or failure in the healing process. The doctor typically plans the treatment, according to the severity of the fracture and the age of the patient.
Symptoms of femoral neck fracture:
The trochanteric fracture or FNF can be either a stressed one or a displaced one. A stress fracture is characterized by the symptoms like referred pain in the thigh and knees, pain in the groin, which goes medially. The doctor checks if there are any clinical deformity and discomfort during the active or passive movement of the hip. The doctor will check if the patient has a muscular spasm in the extreme motion. The patient may also feel pain in percussion (tapping on the surface with an instrument to check the tenderness).
On the other hand, a displaced fracture cause pain in the complete hip area. It is checked by moving the leg in abduction and external rotation.
Causes of femoral neck fracture (Hip Fracture):
The most common causes of the femoral neck fracture are:
- Fall
- Accidents
- Trauma
In most of the cases of the elderly patient, the fracture happens while falling either due to the direct impact on the hip; or due to a twist, where the body rotates, and the foot remains at the same position. The elderly people with osteoporosis and osteomalacia are more prone to such fractures, because the bone loses the elasticity, and becomes brittle with age.
In the younger people, who are under the age of 50, the femoral neck fractures occur as a result of trauma with high energy, which is less common than the fracture occurs in the elderly people. Mostly, they are associated with the osteonecrosis and non-union of the femoral head.
Complications of femoral neck fracture (Hip Fracture):
Femoral neck or trochanteric hip fracture can cause many complications. It can increase the risk of future dependence and can also reduce the survival rate, particularly in the elderly people. Most of the patients with hip fracture are unable to live independently. If the patient recovers, it also takes a long time. Some of the common complications are:
- Blood loss in the closed (not obvious unless there is any swelling)
- Bedsores
- Pneumonia
- Urinary tract infection.
- Blood clots in the legs and the lung.
- Loss of muscle mass.
- Increases the risk of further falls/injury.
- Deep vein
- Pulmonary embolism
- Infection
- Fat embolism
- Non-union
- Other
Warning: The people, who experience a hip fracture in the past, are significantly at greater risk of having another hip fracture.
Treatments:
Femoral neck fracture is managed through following ways:
- Medication
The medication is prescribed mainly to manage the pain. Initially, Acetaminophen and Non-steroidal inflammatory medications are used to address the pain. If it does not give any relief, then opiates are given to fix the problem. Your doctor frequently adjusts the dose of the medications as per the requirement.
- Surgical Intervention:
Usually, the inclusion criteria of the surgery depend on the patient’s age and the amount of the displacement. If the patient is under the age of 60 years, the doctor may not suggest a partial hip replacement because it wears out if the patient is highly active. A study published in the Journal of Arthroplasty, surgical intervention is one of the best treatment options for the elderly patients with a proximal femoral neck fracture. The study also says that early surgical intervention can provide early mobilization, and enhance the walking capacity. The treatment also prevents the related complications like pulmonary infection, urinary infection, cardiac problems, thrombotic events, etc.
- Hip Pinning:
Hip pinning is done when there is minimum displacement of the ball of the femur but is still in the alignment. However, it is also applicable if the alignment is not proper. It is performed under spinal or general anesthesia. Hip pinning is recommended for the younger patients to avoid the hip replacement. In this procedure, the screws are placed along the fractured bone.
The surgeon makes a small incision and puts the screws to stabilize the bone. After the surgery, the pain subsides once the bone heals. If the bone does not heal, or death of the bone occurs due to blood loss, then your doctor may suggest a hip replacement.
- Hemiarthroplasty:
Hemiarthroplasty is recommended for the treatment of displaced femoral neck fracture for less active, elderly patients. In this procedure, an incision is made outside the hip. Then, the ball of the bone is removed out, and replaced by a metallic graft or prosthesis. The surgery is done under the spinal or general anesthesia. With proper rehabilitation, the patients can be benefited with early mobility and better functional activity, with less chance of re-operation.
- Total hip replacement:
Nowadays, total hip replacement is done by minimally invasive technique. It is mostly recommended if the socket joint in the hip is damaged. In the procedure, the surgeon replaces both the top portion of the femur and the joint part of the pelvic bone. The patient, who undergoes the procedure, is benefitted with early mobility, just after a few days of the surgery. The risk of complication is also very low in this technique, but it is still advisable to consult with few experts to ensure the suitability of the treatment.
Physiotherapy for faster recovery:
Physiotherapy with the rehabilitation program helps get faster recovery. Your physiotherapist trains you in the exercise or activities. Some of them are:
- Strengthening exercise:
It helps in strengthening the abductor muscle of the hip, gluteus mediums and the other muscles of the hip region.
- Running:
You should start it under the proper supervision of the expert. Initially, you are trained to run slow for a small distance. Gradually, the distance is increased. If you feel pain, a break for a few days is recommended.
- Aerobic Exercise:
Aerobic exercise is essential for rehabilitation. For this, upper body exercise, non-weight bearing exercise, and swimming are beneficial for strengthening the joint.
Preventive measure:
According to the World Journal of Orthopedic, the femoral neck fractures account almost 50% of the hip fractures, and most of the patients face it after a simple fall. However, one can prevent the risk of hip fracture by following the preventive measures:
- The arrangement of building railings or ramps with stairs around the home.
- Keeping the rails next to the bathtub, shower, and toilet also a good measure for elderly people.
- Arrange your furniture in such a way so that it can give you clear way.
- Always keep the cords stowed away.
- Avoid stepping tools, and ladders where there is a risk of losing the balance.
- Always try to keep your house moist free.
- Don’t use slippery rugs or carpet.
- Wear shoes which are non-slippery.
- Do not smoke, because it reduces the bone density, and makes it more prone to fracture.
According to the studies, senior citizens have more than 50% risk of a hip fracture, but it does not mean that you cannot avoid it. Instead, be careful and understand its preventive measures, so that you can be on the safe side. Regular exercise and a proper calcium intake in the young age can also help reduce the chance of hip fracture. Apart from that, following doctor’s instructions and taking precautions can help you avoid the unnecessary risk of hip fracture. So you can have a better tomorrow by preventing it today.
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Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.
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