Proximal Femoral Fracture

An Overview

A hip fracture  or Proximal femoral fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. Risk increases because bones tend to weaken with age (osteoporosis). Multiple medications, poor vision and balance problems also make older people more likely to fall one of the most common causes of hip fracture. A hip fracture almost always requires surgical repair or replacement, followed by physical therapy. Taking steps to maintain bone density and avoid falls can help prevent a hip fracture.The majority of hip fractures, though, happen to people over 60. For them, a simple fall is the most common cause — though a small percentage of patients experience spontaneous fractures.Hip fractures can cause a number of complications. In older patients, these include:
• A greater chance of death (about 20 percent of patients die within a year)
• A challenging recovery (only an estimated 1 in 4 patients fully recover)
• A long hospital stay (1 to 2 week average), with possible rehab facility admission.

Types of Hip Fracture

• Femoral neck fracture: A femoral neck fracture occurs one to two inches from the hip joint. These fractures are common among older adults and can be related to osteoporosis. This type of fracture may cause a complication because the break usually cuts off the blood supply to the head of the femur which forms the hip joint.
• Intertrochanteric hip fracture: An intertrochanteric hip fracture occurs three to four inches from the hip joint. This type of fracture does not interrupt the blood supply to the bone and may be easier to repair.

Symptoms of Hip Fracture

  • Signs and symptoms of a hip fracture include:
  •  Inability to get up from a fall or to walk
  • Severe pain in your hip or groin
  • Inability to put weight on your leg on the side of your injured hip
  • Bruising and swelling in and around your hip area
  • Shorter leg on the side of your injured hip
  • Outward turning of your leg on the side of your injured hip
  • Bruising or swelling
  • Foot turned out at an odd angle, making the leg look shorter
  • A feeling of tendonitis or muscle strain (stress fractures only)

Causes of Hip Fracture

  • A severe impact  in a car crash, for example  can cause hip fractures in people of all ages. In older adults, a hip fracture is most often a result of a fall from a standing height. In people with very weak bones, a hip fracture can occur simply by standing on the leg and twisting.
  • Not being active. Weight-bearing exercise, such as walking, helps keep bones strong.
  • Smoking.
  • Medical conditions that cause dizziness or problems with balance, or conditions such as arthritis that can interfere with steady and safe movement.
  • Taking certain medicines, such as long-term steroid medicines used to treat asthma or COPD
  • Femoral neck. The area of the femur below the ball (femoral head).
  • Intertrochanteric area. The area below the neck of the femur and above the long part or shaft of the femur. It is called intertrochanteric because it is marked by two bony landmarks: the greater trochanter and the lesser trochanter.
  • Subtrochanteric area. The upper part of the shaft of the femur below the greater and lesser trochanters.
  • Femoral head. The ball of the femur that sits in the socket.
  • In some cases, the bone may be so weak that the fracture occurs spontaneously while someone is walking or standing. In this instance, it is often said that “the break occurs before the fall.” Spontaneous fractures usually occur in the femoral neck.
  • Stress fractures or fractures from repeated impact may also occur in the femoral neck. These fractures are often seen in long distance runners, particularly military recruits in basic training. When stress fractures occur in the subtrochanteric region of the hip, they are usually associated with prolonged use of certain osteoporosis medications.

Diagnosis

  • Often your doctor can determine that you have a hip fracture based on your symptoms and the abnormal position of your hip and leg. An X-ray usually will confirm that you have a fracture and show where the fracture is. The femoral neck. This area is situated in the upper portion of your femur, just below the ball part (femoral head) of the ball-and-socket joint.
  • The intertrochanteric region. This region is a little farther down from the hip joint, in the portion of your upper femur that juts outward.
  • Magnetic resonance imaging (MRI) scans. An MRI scan provides fine images of both soft tissue structures and bone. Because it is very sensitive, it can sometimes detect a small or incomplete fracture that cannot be seen on an x-ray
  • Surgery. The type of surgery you have generally depends on the where and how severe the fracture is, whether the broken bones aren’t properly aligned (displaced), and your age and underlying health conditions. The options include:
  • Internal repair using screws. Metal screws are inserted into the bone to hold it together while the fracture heals. Sometimes screws are attached to a metal plate that runs down the femur.
  • A small number of femoral neck fractures may be treated without surgery. These are typically nondisplaced fractures in young healthy patients. Because there is a risk of displacement, they need to be monitored carefully. Nonoperative treatment consists of limited or protected weight bearing with crutches for several weeks.
  • In some younger patients, it is desirable to preserve the natural femoral head rather than do a replacement. In these patients an open reduction is performed. This involves making an incision over the hip joint, putting the bone back into place, and then holding the bone with pins, screws, or another type of metal fixation.

Prevention

  • Consuming enough vitamin D and calcium — including such calcium-rich foods as milk, cottage cheese, yogurt, sardines and broccoli.
  • Getting a bone density test if you fall into a higher-risk category for osteoporosis.
  • Engaging in regular weight-bearing exercises, such as walking, jogging or hiking, or improving strength and balance through programs like Tai Chi.
  • Taking medications to prevent bone loss or spur bone growth, as prescribed by your doctor (fracture patients are at high risk for additional fractures)
    Hope this Symptoms and cure article will be helpful to all. Do not forget to share your valuable suggestions if any.

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