Fracture neck of femur in old age - Why surgery is almost the only option?
Hip fractures are common injuries in older populations. Delaying hip replacement surgeries on elderly patients with hip fractures is linked with morbidity and mortality. (1). The femoral neck connects the shaft with the femoral head. The hip joint is a complex ball and socket synovial joint that fuses between the top of your thigh bone and the acetabulum (part of the pelvis). The junctional position and osteoporosis of bone make the femoral neck prone to fracture. Femoral neck fractures are intracapsular fractures. The capsule contains the synovial fluid that nourishes and lubricates the hip joint.
Hip Fracture Symptoms
These are some signs and symptoms of a fractured hip -
Bruising, bruising and swelling around the hip joint.
Severe pain in the hip.
Inability to move the legs after falling or trauma to the hip region.
The injured leg turns outward.
Inability to bear your weight on the injured or painful leg.
The leg on the injured side of the hip appears to be shorter.
What Makes Hip Fractures Detrimental for the Elderly?
Hip fractures can be detrimental to older people. Here are some factors that make hip fractures a very terrible condition for the elderly;
Decreased muscle mass and bone density –
This is because muscle mass and Bone density tend to decrease with age. The leading factor is osteoporosis which is common among the elderly, especially women. The disease causes bones to become weak and brittle. (2)
Unable to unite-
Chance of union of fracture neck of femur in elderly (after 50’s) is low. Old treatment modalities like bed rest, traction has proved to increase chance of significant morbidity (E.g. Bed sore, Pulmonary infection, Urinary tract infection) and mortality (10% in a month and 30% in a year).
Presence of other conditions
Diabetes - Recovery can be more difficult in type1 and type 2 diabetes because of poor wound healing and poor bone remodeling.
Menopause - weaker bones are linked to lower estrogen levels due to osteoporosis.
Malnutrition - lack of nutrients delays healing after a fracture and hip surgery leading to poorer outcomes for elderly patients.
Dementia - After surgery, regaining total mobility is often a challenge for dementia patients as they are prone to falls and do not follow recovery protocols. This set of people is kept in nursing homes.
Recovery after hip replacement for fracture neck of femur
The recovery time for a hip replacement surgery range from six weeks to six months but it takes more time for older people. The more comorbidities they have, the longer it takes. The type of surgery done can also determine the recovery period as most people suffer more than one hip fracture.
Hip replacement surgery is an effective procedure that involves the removal of damaged parts, using artificial materials made from ceramic, plastics, titanium, and hard plastics. Depending upon the pre-injury status, your doctor will decide either total hip replacement or hemi-replacement hip. Your doctor also might decide to fix the fracture if it is lower down (per-trochanteric).
For hip fractures in the elderly, it is advisable to schedule surgery as soon as possible. NICE guidelines recommend surgery within 48 hours to reduce significant morbidity and mortality in patients.
References
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