Written By: Dr. Jassin Jouria
An 81-year-old male is brought to the Emergency Room after tripping on an object while walking into a store. His son called an ambulance after he could not help his father stand back up. The man say he has pain on his right-side hip that is much worse when he attempts to stand. He says the pain radiates down the side of his right leg. Plain X-rays show an intertrochanteric fracture of the right hip.
Hip Fractures- Some Statistics
Hip fracture is one of the most dreaded complications of a fall. It is associated with a decline in mobility and a loss of one’s quality of life. Hip fractures are one of the most common procedures done by orthopedic surgeons. In the U.S., more than 300,000 people over 65 get hospitalized due to hip fractures. More than 95% of hip fractures are the direct consequence of falling.
Why are the Consequences of Hip Fractures from Falling?
Hip fractures can have profound effects on the elderly. These effects can be classified into 3 categories.
Intraoperative Complications
Surgeries to correct hip fractures can be major and can have a variety of intraoperative complications such as:
- Dislocation of the hip
- Implant failures
- Damage to the soft tissues, nerves, and blood vessels
- Blood loss
- Anesthesia-related complications
Postoperative Complications
The postoperative complications related to a high-risk surgery can include:
- Deep tissue or bone-related infections
- Continued blood loss following the surgery
- Higher risk of blood clots in the legs and the lungs (pulmonary embolism)
- Pressure scars
- Pneumonia
- Urinary tract infections
- Electrolyte abnormalities
- Pain
- Bedsores
Effects of Quality of Life
The most significant consequence of hip fracture is on one’s quality of life. Following is how hip fractures might affect one’s quality of life:
- The 1-year mortality (chances of death) after a hip fracture can be as high as 58%
- Significant loss of muscle mass
- Balance issues
- The inability of weight bear
- Reduction in mobility and increased reliance on the use of help with walking
- Inability to do the things one was able to do before the hip fracture like walking freely or going out
What are the Risk Factors for Hip Fracture From Falling?
Not everyone who has a fall will experience hip fractures. Some risk factors increase the chance of a hip fracture, like:
- Age: Elderly individuals are at a higher risk of experiencing hip fractures.
- Gender: Females are three times more likely to experience hip fractures from a fall.
- Osteoporosis: Osteoporosis makes the bones brittle and weak. The chances of hip fracture are higher among individuals with osteoporosis.
- Medical conditions: Medical conditions such as hyperactive thyroid, vitamin D, and calcium deficiency can make the bones weak. Some conditions increase the risk of frequent falls and hip fractures. These include Parkinson’s, dementia, peripheral neuropathy, and balance problems.
- Nutritional deficiencies: Calcium and vitamin D are necessary for bone health. Inadequate intake of these nutrients leads to poor bone mineral density. A decline in bone mineral density increases the risk of hip fractures.
- Certain medication: Medications can increase the risk of falling and the risk of hip fracture as well. These include medication for high blood pressure, heart conditions, anti-psychotics, anti-anxiety pills, and so on. Also, certain medications increase the risk of hip fracture by declining bone mineral density.
- Physical inactivity: Besides proper nutrition, physical activity helps improve bone mineral density. A lack of physical activity leads to weaker muscles and bones.
- Smoking and drinking: Both smoking and drinking reduce bone mineral density and increase the risk of hip fracture.
What is the Treatment of Hip Fracture?
Most people require urgent surgery for the treatment of hip fractures. The type of surgery for hip fractures depends on:
- The pattern of hip fracture
- Age of the patient
- Mobility of the patient before fall
- Presence of other conditions such as arthritis, dementia, and so on.
There are three main methods for treating hip fractures.
- Internal fixation: In this procedure, nails, rods, and plates are used to keep the fractured segments of the hip bone in place. This approach is used if the patients are frail, can’t tolerate major surgery, or if the fracture pattern has not led to a significant displacement of bones.
- Hemiarthroplasty: This is the preferred type of hip replacement. In this method, only the top of the hip bone (femoral head) is replaced by a prosthesis (false bone).
- Complete hip replacement: In this method, both the femoral head and the socket in the hip are replaced by a prosthesis. It is a major surgery and is usually reserved for people with a very good level of activity pre-surgery.
How can you Prevent the Risk of Hip Fractures?
As mentioned, you can end up having major surgery following a hip fracture. It is better if you observe caution and reduce the risk of having a hip fracture in the first place. You can reduce the risk of hip fractures in the following ways:
- Improve your bone health: Individuals with osteoporosis are more likely to experience a hip fracture. Improving your bone quality by eating a diet rich in calcium, vitamin D, and other nutrients can help improve bone quality.
- Exercising regularly can improve your muscle and bone health and can reduce the risk of falling and fracture from falling.
- Avoid smoking and drinking.
- Assess home risks that increase your risk of falling like loose carpeting, poor lighting, and so on.
- Discuss with your doctor about any medication. These include medicines that increase your risk of falling or might compromise your bone health.
Get an appointment with your optometrist and get your eyes checked.
Meet the Author Dr. Jassin Jouria
Dr. Jassin Jouria is a practicing Emergency Medicine Physician who specializes in resuscitation of critical patients. The majority of his clinical work is at the Decatur County Memorial Hospital Emergency Department in Greensburg, Indiana. Learn More About the Author.
References:
https://www.cdc.gov/falls/hip-fractures.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597289/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7248161/
https://www.uptodate.com/contents/complications-of-total-hip-arthroplasty
https://www.mayoclinic.org/diseases-conditions/hip-fracture/symptoms-causes/syc-20373468
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