Hip fractures

Hip fractures are one of the most serious conditions in orthopedic surgery, with particularly significant effects on the patient’s quality of life, mobility and functionality. They usually occur in older people, often as a result of a fall or injury, and may require urgent surgery to repair the hip joint.

Hip fractures can occur in various areas of the thigh and pelvis, with the most common being the neck area of the femur. The nature of the fracture, the age and general condition of the patient determine the choice of treatment and the approach to rehabilitation.

Hip fractures are usually caused by falls, but risk factors include osteoporosis (which makes bones more fragile), age, and various other conditions such as arthritis, balance disorders, or poor physical condition.

According to research, osteoporosis and weakening bone density are the main risk factors for hip fractures in older people. The 2018 study by [Davis et al.] (J Orthop Trauma, 2018) finds that about 30% of people over the age of 65 will suffer at least one fracture during their lifetime, with hip fractures being among the most common.

Hip fractures are mainly categorized according to the point and severity of the injury:

1. Femoral neck fractures: These are the most common hip fractures and occur in the upper femur. These fractures may cause a disruption in the blood supply to the area, which can lead to necrosis of the femoral head.
2. Femoral fractures: These fractures occur in the central part of the femur.
3. Pelvic fractures: These are injuries that involve the pelvic area and can be more complicated. Pelvic fractures may require specialized surgery and rehabilitation.

The most common symptoms of a hip fracture include:

• Acute pain in the hip or pelvis
• Difficulty moving and walking
• Inability to cope when standing
• Painful deformity or limited mobility in the hip area

The diagnosis is made through clinical examination and X-ray. In some cases, other imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI), may be required to accurately assess the fracture and the involvement of surrounding tissues.

Treatment of a hip fracture depends on the type of fracture, the patient’s age, his general condition and the surgeon’s preferences. Basic treatment options include:

1. Conservative Treatment (without surgery):In some cases or in milder fractures, conservative treatment can be done with rest, physiotherapy and the use of walking aids (e.g. crutches). This approach is used less frequently, as hip fractures often require emergency surgery.
2. Surgical Rehabilitation: Most hip fracture patients require surgery to repair the bone and avoid further complications. Surgical options include:

• Internal Stabilization (e.g., plates and screws):This method is mainly used for femoral neck fractures. The bone is held together with plates and screws to achieve stability and quick recovery.
• Total Hip Arthroplasty (Total Hip Replacement):In cases of severe fractures or when there is significant arthritis or degenerative alteration of the joint, total hip arthroplasty may be the best option. This surgery involves the complete replacement of the hip with an artificial implant.
• Semi-Arthroplasty of the Hip: In some cases, especially in elderly patients, semi-arthroplasty may be the most appropriate treatment, replacing only the femoral head.

Recovery after surgical repair of a hip fracture is critical for restoring mobility and preventing postoperative complications. Immediately after the operation, the patient should follow a physiotherapy program, which includes strengthening and mobility exercises, under the guidance of a physiotherapist.

Physiotherapy can start from the first days after surgery and continue for several months. Faster restoration of mobility reduces the chances of complications, such as developing blood rust, and helps the patient return to their daily activities.

As with any surgery, complications are always possible, although with modern techniques and early intervention the risks have been significantly reduced. The most common complications include:

• Infection of surgical wound
• Thrombosis (e.g. venous thromboembolism)
• Failure of implant placement or loosening of implant
• Neurovascular damage in the wider area