Hip fractures: what can be done?

You may not often consider the importance of the hip. This joint supports our weight as we move, allowing us to walk or run. Hip fractures are not uncommon, nor should they be sniffed at. They can be very serious injuries with a lengthy recovery process. What can be done about them? Leading orthopaedic surgeon Mr Alex Chipperfield is here to explain.

What is the most common cause of a hip fracture?

Hip fractures (broken hip) are very common, with around 80,000 cases per year in the UK. It is a condition that is associated with the elderly (the average age for somebody to break their hip is 84) and this number will increase as the population gets older and people are living longer.

The majority of hip fractures are caused by age-related weakening of the hip bones (osteoporosis) associated with a minor fall from standing height.

A combination of weaker bones, poor balance and general frailty associated with old age all put people at risk of this injury.

Why is a hip fracture so dangerous?

Hip fractures tend to be associated with old age and frailty, and often can indicate the start of a general deterioration in health.

Around 25% of people who break their hips are already living in institutional care, and will often have several other chronic health problems in addition to their injury.

Around one third of people who break their hips will die within a year.

Most deaths are due to associated medical conditions rather than the break or treatment itself.

Can you walk with a hip fracture?

Generally, no.

A broken hip is a painful condition and in the majority of cases will result in being unable to bear weight until the hip is operated on.

Being immobile can result in people developing serious problems such as blood clots, pneumonia and pressure ulcers, hence the need to perform surgery quickly to allow patients to mobilise out of bed.

When is surgery needed for a hip fracture?

Surgery is needed in almost all cases of broken hips.

The timing of this operation is critical. There is a large amount of scientific evidence to suggest that the sooner somebody has their surgery, the better. Rapid surgery is essential to help with pain relief and prevent complications associated with prolonged immobility. This need for rapid surgery must, of course, be balanced with safety concerns as well. Many patients will have pre-existing medical conditions that may need optimising before surgery to ensure that the operation itself is safe and the risks of perioperative complications is minimised.

In the UK we aim to perform hip fracture surgery within 36 hours of admission. This is a national standard that is achieved approximately 70% of the time across the country.

What does hip fracture surgery involved?

The type of surgery required depends on the type of break that the hip has suffered.

Essentially, there are two options – fix the bone or replace it.

For a break that is far enough below the hip joint (extracapsular fracture), the bone can be fixed. This will be either with a metal plate and screws, or a long rod that sits inside the thigh bone (intramedullary nail).

For a break very close to the joint (intracapsular fracture), the joint itself will be replaced, either with a half hip replacement (hemiarthrioplasty) or in some cases a total hip replacement.

Whatever the operation performed, the aims are the same: to alleviate pain and allow immediate fully weight-bearing mobilisation.

What can you do to speed up recovery from hip fracture surgery?

Studies have shown that if an elderly patient spends a week in bed this equates to ageing by 10 years.

Therefore it is vital that after hip fracture surgery you are mobilising as soon as possible.

This early mobilisation starts with early surgery, with an implant that will allow full weight bearing from the first step.

Early physiotherapy input on the day of or day after surgery is important, as is following the rehabilitation protocol they will devise.

Mobilisation can help reduce the risk of complications such as pneumonia, urinary infections and delirium, all of which can slow recovery.

Nutrition is essential in the postoperative period. A high number of people with hip fractures are malnourished on admission to hospital and will require nutritional supplementation in hospital. Patients who receive this treatment recover more quickly and are less likely to develop problems.

Visit Mr Chipperfield’s Top Doctors profile to book an appointment.