Hip fracture

treatment

Hip fractures are usually treated in hospital with surgery.

Most people will need surgery to fix the fracture or replace all or part of their hip, ideallyon the day they're admitted to hospital or the day after.

There are a number of different operations, which are described below. The type of surgery you have will depend on:

the type of fracture you have (where in the femur the fracture is)
your age
how physically mobile you were before the hip fracture
your mental ability to take part in the post-surgery rehabilitation programme
the condition of the bone and joint for example, whether or not you have Arthritis

Internal fixation

Internal fixation means usingpins, screws, rods or plates to hold the bone in place while it heals.

It tends to be used for either:

extracapsular fractures(outside the socket of the hip joint)
intracapsular fractures (inside the socket of the hip joint)if they'restable and haven't moved significantly (undisplaced)

If internal fixation is used for an intracapsular fracture, you'll need follow-up appointments over several months with X-rays to check you're healing well.

Hemiarthroplasty

Hemiarthroplasty means replacing the femoral head with a prosthesis (false part). The femoral head is the rounded top part of the femur (upper thigh bone) that sits in the hip socket.

The procedure is often the preferred option for intracapsular fractures (inside the socket of the hip joint), which occur in people who already had reduced mobility before the fracture.

In this type of fracture, a replacement is the preferred option, as the fracture is unlikely to heal well.

Complete hip replacement

A completehip replacement is an operation to replace both the natural socket in the hip and the femoral head with prostheses (false parts).

This is a more major operation than hemiarthroplasty and isn't necessary in most patients, but may be considered if you already have a condition that affects your joints, such as arthritis, or you're very active.

Pre-operative assessment

Providing you're in a stable condition, you'll ideally have surgery within 36 hours of arriving at hospital.

You'll have a pre-operative assessment to check your overall health and make sure you're ready for surgery.

During your assessment you'll be asked about any medications you're currently taking, andany necessary tests and investigations will be carried out.

You'll also have an anaesthetic assessment todecide whattype of anaesthesia to use. Different types include:

spinal or epidural anaesthesia used to numb the nerves in the lower half of your body so you can't feel anything inthis area
general anaesthetic which makes you unconscious so you can't feel anything

Before surgery

Hip fractures can be very painful. During diagnosis and treatment, you should be given medication to relieve your pain.At firstpain relief isusually given intravenously (through a needle into a vein in your arm), with a local anaesthetic injection near the hip.

Before your operation you'll be given antibiotics . This isto reduce the risk of your wound becoming infected after surgery.

Surgery carries the risk of a blood clot forming in a vein, so steps will be taken to reduce this risk. For example, you may have injections of heparin, which is an anticoagulant that reduces the blood's abilityto clot.

You'll continue to be monitored for blood clots during your stay in hospital. You may still need medication after you're discharged.

Your operation

The operation may takea couple of hours.

If you have any questions about your operation, ask your surgeon or another member of your careteam.

After the operation, you'll begin your rehabilitation programme. This may take place in a different ward to the one where you had surgery.

It involves a long period of bed rest andisn't often used because it can:

make people more unwell in the long-term
involve a longer stay in hospital
slow down recovery

However, conservative treatment may be necessary if surgery isn't possible for example, if someone is too fragile to cope with surgery, or if the fracture occurred a few weeks earlier and has already started to heal.