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Hip fracture surgery

Definition

Hip fracture surgery is done to repair a break in the upper part of the thigh bone. The thigh bone is called the femur. It is part of the hip joint.

See also: Hip pain

Alternative Names

Inter-trochanteric fracture repair; Subtrochanteric fracture repair; Femoral neck fracture repair; Trochanteric fracture repair; Hip pinning surgery

Description

You may receive general anesthesia before this surgery. This means you will be unconscious and unable to feel pain. You may have spinal anesthesia. With this kind of anesthesia, medicine is put into your back to make you numb below your waist.

The type of surgery you have depends on the kind of fracture you have.

If your fracture is in the neck of the femur (the part just below the top of the bone) you may have a hip pinning procedure. During this surgery:

  • You lie on a special table. This allows your surgeon to use an x-ray machine to see how well the parts of your hip bone line up.
  • The surgeon makes a small incision (cut) on the side of your thigh.
  • Special screws are placed to hold the bones in their correct position.
  • This surgery takes 2 - 4 hours.

If you have an intertrochanteric fracture (the area below the femur neck), your surgeon will use a special metal plate and special compression screws to repair it. Often more than one piece of bone is broken in this type of fracture. During this surgery:

  • You lie on a special table. This allows your surgeon to use an x-ray machine to see how well the parts of your hip bone line up.
  • The surgeon makes a surgical cut on the side of your thigh.
  • The metal plate or nail is attached with a few screws.
  • This surgery takes less than 1 hour.

Your surgeon may perform a partial hip replacement (hemiarthroplasty) if there is concern that your hip will not heal well using one of the procedures above. Hemiarthroplasty replaces the ball part of your hip joint.

Why the Procedure Is Performed

If a hip fracture is not treated, you may need to stay in a chair or bed. This can lead to life-threatening medical problems, especially if you are older. Because such serious problems can develop, surgery to fix the fracture is often recommended.

Risks

Following are risks of surgery:

  • Avascular necrosis. This is when the blood supply in part of the femur is cut off for a period of time. This can cause part of the bone to die.
  • Injury to nerves or blood vessels.
  • Parts of the hip bone may not join together at all or in the correct position.
  • Blood clots in the legs or lungs.
  • Mental confusion (dementia): Older adults who fracture a hip may already have problems thinking clearly. Sometimes surgery can make this problem worse.
  • Pressure sores (also called pressure ulcers or bed sores) from being in bed or a chair for long periods.

Before the Procedure

You will likely be admitted to the hospital because of a hip fracture. You probably will not be able to put any weight on your leg or get out of bed.

Tell your doctor or nurse what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.

On the day of the surgery:

  • You will likely be asked not to drink or eat anything after midnight before your surgery. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but do not to swallow.
  • Take the medicines your doctor told you to take with a small sip of water.
  • If you are going to the hospital from home, be sure to arrive at the scheduled time.

After the Procedure

You will stay in the hospital for 3 - 5 days. Full recovery will take from 2 - 3 months to a year.

After surgery:

  • You will have an IV (a catheter, or tube, that is inserted into a vein, usually in your arm). You will receive fluids through the IV until you are able to drink on your own.
  • Special compression stockings on your legs help improve blood flow in your legs. These reduce your risk of getting blood clots, which are more common after hip surgery.
  • Your doctor will prescribe pain medicines. Your doctor may also prescribe antibiotics to prevent infection.
  • You may have a catheter inserted into your bladder to drain urine. It will be removed when you are ready to start urinating on your own. Usually it is removed 2 or 3 days after surgery.
  • You may be taught deep breathing and coughing exercises using a device called a spirometer. Doing these exercises will help prevent pneumonia.

You will be encouraged to start moving and walking as soon as the first day after surgery. Most of the problems that develop after hip fracture surgery can be prevented by getting out of bed and walking as soon as possible.

  • You will be helped out of bed to a chair on the first day after surgery.
  • You will start walking with crutches or a walker. You will be asked not to place too much weight on to the leg that was operated on.
  • When you are in bed, bend and straighten your ankles often to increase blood flow to help prevent blood clots.

You will be able to go home when:

  • You can move around safely with a walker or crutches.
  • You are correctly doing the exercises to strengthen your hip and leg.
  • Your home is ready.

Follow any instructions you are given about how to care for yourself at home.

Some people need a short stay in a rehabilitation center after they leave the hospital and before they go home. At a rehab center, you will learn how to safely do your daily activities on your own.

You might need to use crutches or a walker for a few weeks or months after surgery.

Outlook (Prognosis)

You will do better if you get out of bed and start moving as soon as you can after your surgery. Health problems that develop after this surgery are often caused by being inactive.

Your doctor and nurse will help you decide whether it is safe for you to go home after you have had this surgery to repair your hip fracture.

References

Butler M, Forte M, Kane RL, et al. Treatment of common hip fractures. Evid Rep Technol Assess (Full Rep). 2009 Aug;(184):1-85, v.

LaVelle DG. Fractures and dislocations of the hip. In: Canale ST, Beaty JH, eds. Campbell'sOperative Orthoaedics. 11th ed. Philadelphia, PA: Elsevier Mosby; 2007:chap 52. 

Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010 Oct 19;182(15):1609-16.


Review Date: 11/15/2012
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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