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What do you do if you fall and break your hip? A fall can result in a hairline fracture to a total break. It might be that instead of injury, you have osteoarthritis in your hip that is causing significant pain that requires surgery. In any case, there are several options for managing a broken hip.

Diagnosis

To determine which is the case, an x-ray is usually performed, and it will tell what kind of fracture and where it is. If hip pain is present but the x-ray doesn’t show a fracture, then magnetic resonance imaging or an MRI may be performed. Hip fractures tend to occur in two different places on the femur, which is the long upper bone of the leg.

One location is the femoral neck or the location of the femur just below the femoral head, which is just below the ball part of the ball-and-socket joint. The second location in the femur that juts out outwards just a little further down is called the intertrochanteric region.

What determines the surgery performed

  • Where and how severe the fracture is
  • Whether the bones are displaced or exactly aligned
  • Underlying health condition
  • Age
  • Post-surgery rehabilitation

Types of surgery

Open reduction and internal fixation (ORIF). This could consist of special rods, wires, nails, screws, and plates the surgeon uses to fix the bones in the correct position. A long rod may be placed in the middle of your thigh bone or femur if there is a fracture. It takes several hours to finish. An ORIF may be done if your bone is broken in several places, sticks through the skin, and moves out of position. Open reduction is putting the bone back in place, while fixation uses the hardware to fix it into the proper position. Concerns about an ORIF include swelling, infection, and hardware mobility. Age, the fracture's severity, location, and type of bone broken are also concerns.

Partial hip replacement. This is where a rod is inserted into the femur with an artificial ball at the end. The femoral head is replaced instead of the socket, as in a total hip replacement. This procedure is usually done in older patients who have fractured their hip.This procedure is called a hemiarthroplasty. It takes one to three hours to finish. The procedure is used in cases of displaced fracture, avascular necrosis of the femoral head, and older, less active individuals with other medical issues because it is faster and far less problematic than an ORIF.

Total hip replacement (THR). This is where both the socket of the pelvis and the ball are replaced. The socket is replaced with a heavy-duty plastic cup, which may or may not include a titanium metal shell. Your femoral head will be replaced with a ball made from a metal alloy or maybe a ceramic material. There are 3 approaches to a hip replacement, anterior, anterolateral, and posterolateral. Of the three, the anterior, where the incision is made on the front of the hip, is less problematic to the soft tissue and muscles around it. That is why surgeons use a custom operating table and a type of x-ray called fluoroscopy to direct implant placement. This is not customarily used with the other two procedures.

Hip resurfacing. This process preserves more of your hip bone. A cap is placed over your femoral head. It is hollow and mushroom-shaped. Designed if you are an active individual under 60 years old. Provides a more stable hip joint than a traditional total hip replacement. and particularly if you are active. Resurfacing can improve the outcome of revision surgery if you require one later in life. Problems may occur like nerve injury, femoral fracture, or metal wearing inside the joint so that you may need revision surgery or a THR later.

Following any ORIF or replacement medication to prevent blood clots and infection and to manage pain is required.

Recovery

After an ORIF, you may go home the same day or within one to several days, with total recovery taking three to twelve months. This recovery time depends on the bone you broke and how bad the break was. The hardware is not removed. It takes four weeks to four months to recover from a partial hip replacement, with each person recovering in their own time. In a THR, you can go home in two to three days, with a total recovery time taking ten to 12 weeks for a full recovery.

Hip precautions for hip replacements

These precautions are so you do not dislocate your hip. Do not bend at the hip, so the hip is less than ninety degrees, or sit with your knees higher than your hips. Sit in a chair that is higher at the hips than the knees. This also includes no squatting. Avoid crossing the legs or the feet. Do not move the toes inward or outward. Avoid twisting at the hips keeping hips, knees, and feet facing forward. The surgeon determines weight-bearing status.

Avoid sudden movements that can result in an injury. Ways to manage these precautions is to sleep with a pillow between your legs. A pillow should rest under the operated leg and on top of the other leg when lying down. This helps with turning onto the side without twisting at the hips. Sit in a chair that is higher at the hips than the knees. These precautions last at least six weeks.

Resources

https://www.mayoclinic.org/diseases-conditions/hip-fracture/diagnosis-treatment/drc-20373472

https://www.hss.edu/conditions_understanding-implants-in-knee-and-hip-replacement.asp

https://www.physio-pedia.com/Partial_Hip_Replacement

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