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Hip Fracture - ORIF

Introduction
Hip Fractures are most commonly caused by falls.  The risk for Hip Fractures increases with age.  Older adults, especially those over the age of 85, are at the highest risk because of changes in bone structure and overall health.  Medical complications from hip fractures can be life threatening.  Because of the possible serious consequences, you should see your doctor or go to the Emergency Department of a hospital immediately if you suspect that you fractured your hip.

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Anatomy
Our hip joint is a ball-in-socket joint.  Our pelvis bone has a cup-shaped socket that holds the top of our thigh bone in place and allows it to rotate during movement.  The cup-shaped socket is called the Acetabulum.  Our thigh bone is called the Femur and is the strongest bone in the body.  The top of the Femur is shaped like a ball and called the Femoral Head.  The Acetabulum and the Femoral Head form our hip joint.
 
The Femoral Head is attached to the Femur by small section of bone called the Femoral Neck.  The Femoral Neck attaches to the Femur between two projections of bone called the Greater Trochanter and the Lesser Trochanter.  The long length of bone on the femur that we refer to as our thighbone is called the Shaft.
 
The primary function of the Hip Joint is to support the weight of our head, trunk, and arms while we are still or moving.  The Hip Joint provides a base of support that allows us to hold our body upright when we sit or stand.  Likewise, the Hip Joint provides stability for our upper body while positioning the lower body for movement.  The Hip Joint allows our legs to move to the front and back and from side to side as we walk, run, and climb stairs.  The Hip Joint also allows our legs to rotate inward and outward.  We rotate our legs when we place our feet on the ground.  We angle our toes inward or outward for balance.

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Causes
A Hip Fracture is caused by trauma.  A Hip Fracture occurs when the top part of the Femur breaks.  Falls are the most common cause of Hip Fractures in older adults, and the risk increases with age.  Automobile crashes, a source of high force trauma, can cause Hip Fractures at any age.
 
Women experience more Hip Fractures than men.  Women may be more susceptible because of differences in their skeletal structure and bone composition.  Additionally, women may have higher rates of bone density loss from Osteoporosis, a bone weakening disease.  For both women and men, bone density generally decreases after the age of 50.
 
Falls are the leading cause of injury for older adults.  Interestingly, the type of fall that typically causes a hip injury takes place on a level surface as opposed to falling down a flight of stairs.  Individuals tend to fall from a standing position or from a sitting position on a chair or bed.  This may be because some older adults develop slow and weak body movements.  They may have difficulty compensating for changes in position.  These individuals may not be able to carry their bodies forward to fall on their hands.  Instead, they tend to fall back or sideways onto their hips.
 
Side effects or interactions from medication can cause balance problems associated with falls.  Older adults that take four or more medications or certain types of medications have the highest fall risk.  Medications such as sleeping pills, tranquilizers, and anti-anxiety drugs may cause changes in vision, movement, and balance.
 
Some medical conditions are associated with an increased risk for falls.  These include Parkinson’s Disease, stroke, and arthritis, plus any diagnoses that causes a change in thought processing or vision. 

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Symptoms
You will feel pain when your Femur breaks.  The pain will increase when you attempt to move your thigh.  You may not be able to stand or put weight on your leg.  Your leg may turn outward at an extreme angle or appear to be shorter than your other leg.  If you suspect that you fractured your hip, you need to be seen by your doctor or go to the Emergency Department of a hospital immediately.

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Diagnosis
Your doctor will make a diagnosis by examining you and asking you what has happened to cause the injury.  Doctors order X-rays to confirm a Hip Fracture.  X-rays provide a good picture of the bones in the hip joint.  They can show exactly where the Femur broke and how far out of place the pieces have moved. 
 
Some fractures do not show up on X-rays.  Your doctor might order a Magnetic Resonance Imaging (MRI) scan for a very detailed view of your hip structure.  Like the X-ray, the MRI scan is painless and requires you to remain very still while the images are taken.
 
Hip Fractures are classified by the location of the fracture.  Your doctor can determine which type you have experienced by viewing your medical images.  The most common fractures are Femoral Neck Fractures, Intertrochanteric Fractures, and Subtrochanteric Fractures. 

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Surgery
Treatment for Hip Fractures typically involves surgery.  The rare exception is for individuals that cannot tolerate the risks associated with anesthesia.  In a very small number of cases, the fracture is allowed to heal while the individual remains in bed for several weeks.  This is very risky with respect to the development of other significant medical problems.
 
Hip Fracture surgery is highly individualized.  The type of surgery depends on the location of the fracture.  Your surgery can take place as soon as you are medically stable.  This is an inpatient surgery, requiring hospitalization.  You will be admitted to the hospital for the surgery and can expect to spend a few days there while you recover. 
 
You will have spinal or general anesthesia for the surgery.  Your surgeon will make an incision at your hip and realign your broken bones.  This procedure is called an Open Reduction.  Your surgeon will use surgical hardware, termed Internal Fixators, to hold your bones in place while they heal.  The complete surgical procedure is called an Open Reduction and Internal Fixation (ORIF).
 
The type of surgical hardware used depends on the type of fracture.  Femoral Neck Fractures are commonly treated with multiple surgical screws.  In some cases, the Femoral Head is replaced with an artificial piece.  This procedure is called a Hemiarthroplasty.  A side plate and metal surgical screws are used for Intertrochanteric Fractures and Subtrochanteric Fractures.  Some Subtrochanteric Fractures are secured with a metal rod that inserts into the bone.

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Treatment

You will need to use a walker or crutches while standing and walking.  Your doctor will let you know how much weight to put on your foot.  Your doctor will use  X-rays to see how your bones have healed. 

Following your surgery, your doctor will prescribe physical therapy to help regain range of motion and strength in your hip.  Initially, you will need to build up your strength to roll and sit up in bed.  At first, you will stand with the aid of a device, such as a walker.  As you heal, you will be allowed to place more weight on your affected leg.  Your physical therapist will assist you with walking.  You may need to use a cane or walker until your balance and strength has improved.  As you recover, your physical therapy program will include further exercises to increase your strength and endurance to help you walk as independently as possible.

Your physical therapists will instruct you on Hip Precautions, body positions to protect the hip while it heals.  They may also recommend durable medical equipment for your home, such as a raised toilet seat or a shower chair.  The equipment may make it easier for you to take care of yourself as you heal and help to prevent injury. 

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Recovery
The recovery process from hip surgery is very individualized.  Your doctor will tell you what you may expect.  Generally, it takes about six to eight weeks for a hip fracture to heal.  However, full recovery takes much longer.
 

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Prevention
There are several ways that you can reduce the risk of falls and help to prevent a hip fracture.  A general physical exam, bone density test, and an eye exam could identify medical conditions that are associated with dizziness or loss of balance.  You should talk to your doctor or pharmacist about possible side effects or interactions associated with your medications.  If you are susceptible to falls and live alone, it may be wise to wear a medical alert device to call for emergency help if needed.
 
An occupational therapist, physical therapist, or a family member can help you examine your home and remove any obstacles that may cause you to trip.  It may be helpful to install railings on steps or in your shower.  Durable medical equipment, such as toilet seat risers and shower chairs, may help you function safely and independently. 
 
Low-heeled sturdy shoes may help you maintain proper foot positioning when standing or walking.  A cane or walker may aid your balance.  A physical or occupational therapist can assist you in selecting the most appropriate devices.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.