ESWhat Happens If I Fracture My Hip?
Patients who suffer from a hip fracture usually end up in an ambulance and taken to the nearest hospital. With over 300,000 hip fractures occurring in the United States every year, this likely means that whatever hospital we go to has good experience at treating hip fractures. Like all orthopedic injuries, every fracture is slightly different. But overall, they fall into two categories. Those that can be fixed with internal fixation – using metal plates or rods and screws to fix the bones and those that need to be replaced by either partial hip replacement or full hip replacement. No matter what the fixation strategy, the goal of surgery is to allow patients to start mobilizing and ambulating immediately without restrictions.
With countless years of research and investigation it is clear now that a large subset of these fractures, called femoral neck fractures, do much better by receiving replacement over fixation. What this means is that your physician will talk to you about partial or total hip replacement. We usually reserve total hip replacement for patients who are community ambulators, which means those who go out to the store, go shopping, go to restaurants, and are able to walk a few blocks without any issues. This surgery is slightly longer and is associated with slightly more blood loss than a partial hip replacement, which is reserved for patients we refer to as household ambulators – those who mostly get around their house just fine, but do not or are not able to ambulate for many blocks.
Whichever surgery is recommended, we know that patients do better when surgery is performed within 48 hours of presenting to the emergency room. Some of the theory behind this is that as we get older our reserve energy is much lower. So, when we have a fracture, we continue to get weaker every day. Hence, it is important to get this fixed as soon as safely possible and start working aggressively with physical therapy. The good news is that with comprehensive physical therapy, more than 50% of patients can get back to the same function they had prior to falling. This is why we always explain to patients that keeping a positive attitude and working aggressively in PT is very important.
Of course, that does mean that around 50% of patients will not get to their pre-injury function level. This means that if they were not walking with a walker before, they may need one now. Some patients will not be able to return to walking after getting a hip fracture.
“Isn’t My Mom Too Old for Surgery?”
This is the last point that I thought we should cover today, and it is an important topic. Of course, as we get older – in our 80s and 90s – our risk for surgery increases. And by no means are we recommending patients should take elective surgery lightly at this age. But it’s important to recognize that hip fractures are not an elective surgery and the decisions we make are very important. The evidence shows a clear benefit to surgery for hip fracture patients at this age, or any age. We know that without surgery almost 50% of patients will pass away before the following year. What we do know is that with surgery and aggressive physical therapy, we can take that 50% and lower it to 18%. Although that still seems fairly high, that does mean that out of every hundred patients with a hip fracture 32 more patients will be around to spend time with their loving families and continue to be part of their lives.
Of course, we are always open to discussion and consultation if you have had a hip fracture and would like it evaluated or if you had surgery and feel you could be doing better.
Dr. Hrayr Basmajian is the orthopedic trauma medical director at Pomona Valley Hospital Medical Center in Pomona California. He is the founder and CEO of Premier Orthopaedic and Trauma Specialists. Dr. Basmajian is known throughout the United States and the world for his expertise in the treatment of hip fractures including total hip replacement using the anterior approach.