Description

You may receive general anesthesia before this surgery. This means you will be unconscious and unable to feel pain. You may have spinal anesthesia. In this kind of anesthesia, medicine is put into your back to make you numb below your waist.

The type of surgery you have will depend what kind of fracture you have.

If your fracture is in the neck of your femur (the part just below the top of the bone) you may have a hip pinning procedure. In this surgery:

• You will lie on a special table that allows your surgeon to use an x-ray machine to see how well the parts of your hip bone line up.
• Your surgeon will make a small incision (cut) on the side of your thigh. Then your surgeon will put in special screws to hold the bones in their correct position.

If you have an inter-trochanteric fracture (the area below the femur neck), your surgeon will use a special metal plate and special compression screws to repair it. Often more than 1 piece of bone is broken in this type of fracture. In this surgery:

• You will lie on a special table that allows your surgeon to use an x-ray machine to see how well the parts of your hip bone line up.
• Your surgeon will make a surgical cut on the side of your thigh. The metal plate or nail will be attached with a few screws.
• This surgery usually takes less than 1 hour.

Your surgeon may perform a partial hip replacement (hemiarthroplasty) if there is concern that your hip will not heal well using one of the procedures above. Hemiarthroplasty replaces the ball part of your hip joint. See also: Hip joint replacement

Why the Procedure is Performed

If a hip fracture is not treated, most people will have to stay in a chair or their bed. This can lead to other life-threatening medical problems, especially for older people. Because such serious problems can develop, surgery to fix the fracture is often recommended.

Risks

Older adults have a greater chance of fracturing a hip because of other conditions they may have. Some conditions that increase the risk of hip fracture are osteoporosis, dizziness or problems with balance, weak muscles, poor eyesight, brain disorders, and taking medicines that may cause problems.

Ask your doctor about these risks:

• Avascular necrosis. This is when the blood supply in part of the femur is cut off for a period of time. This can cause part of the bone to die off.
• Injury to nerves or blood vessels
• Parts of your hip bone may not join together at all or in the correct position.
• Blood clots in your legs or your lungs
• Mental confusion (dementia): Many people who fracture a hip already have some problems thinking clearly. Sometimes surgery can make this problem worse.
• Pressure sores (also called pressure ulcers or bed sores) from being in bed or a chair for long periods of time.

Before the Procedure

You will most likely be admitted to the hospital because of a hip fracture. Most of the time, you will not be able to put any weight on your leg or get out of bed.

Before the surgery:

• Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

On the day of the surgery:

• You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will stay in the hospital for 3 to 5 days. But full recovery will take from 2 to 3 months to a year.

After surgery:

• You will have an IV (a catheter, or tube, that is inserted into a vein, usually in your arm). You will receive fluids through the IV until you are able to drink on your own.
• Special “compression” stockings on your legs to improve blood flow in your legs. These reduce your risk of getting blood clots, which are more common after leg surgery.
• Your doctor will prescribe pain medicines. Your doctor may also prescribe antibiotics to prevent infection.
• You may have a Foley catheter inserted into your bladder to drain urine. It will be removed when you are ready to start urinating on your own. Usually it is removed 2 or 3 days after surgery.
• You may be taught how to use a device called a spirometer and do deep breathing and coughing exercises. Doing these exercises will help prevent pneumonia.

You will be encouraged to start moving and walking as soon as the first day after surgery. Most of the problems that develop after hip fracture surgery can be prevented by getting out of bed and walking as soon as possible.

• You will be helped out of bed to a chair on the first day after surgery. When you are in bed, bend and straighten your ankles often to increase blood flow to help prevent blood clots.
• You will start walking with crutches or a walker. You will be asked not to place too much weight on to the foot.

You will probably be able to go home when:

• You can move around safely with a walker or crutches.
• You are doing your exercises correctly.
• Your home is ready.

Some people need a short stay in a rehabilitation center after they leave the hospital and before they go home. At a rehab center, you will learn how to safely do your daily activities on your own.

You might need to use crutches or a walker for a few weeks or months after surgery.

Outlook (Prognosis)

You will do better if you get out of bed and start moving as soon as you can after your surgery. Most of the problems that develop after this surgery are caused by being inactive.

Your doctor and nurse will help you decide whether it is safe for you to go home after you have had this surgery to repair your hip fracture.

Alternative Names

Inter-trochanteric fracture repair; Subtrochanteric fracture repair; Femoral neck fracture repair; Trochanteric fracture repair; Hip pinning surgery

References

Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010 Oct 19;182(15):1609-16.

Butler M, Forte M, Kane RL, et al. Treatment of common hip fractures. Evid Rep Technol Assess (Full Rep). 2009 Aug;(184):1-85, v.

Updated: 4/10/2012

Reviewed by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.