What is a Hip Fracture?
A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thighbone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thighbone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.
What does ORIF mean?
Open reduction and internal fixation (ORIF) is a surgical technique employed for the treatment of a fracture to restore normal anatomy and improve range of motion and function.
Anatomy
The hip joint is a “ball and socket” joint. The “ball” is the head of the femur or thigh bone, and the “socket” is the cup-shaped acetabulum. It enables the upper leg to bend and rotate at the pelvis. The joint surface is covered by a smooth articular surface that allows pain-free movement in the joint.
Causes of Hip Fractures
Hip fractures are most frequently caused after minor trauma in elderly patients with weak bones and by high-energy trauma or serious injuries in the young. Long term use of certain medicines, such as bisphosphonates to treat osteoporosis (a disease causing weak bones) and other bone diseases, increases the risk of hip fractures.
Signs and Symptoms of Hip Fractures
The signs and symptoms of hip fractures include:
- Pain in the groin or outer upper thigh
- Swelling and tenderness
- Discomfort while rotating the hip
- Shortening of the injured leg
- Outward or inward turning of the foot and knee of the injured leg
Diagnosis
Most often your physician can determine that you have sustained a hip fracture based on the abnormal position of your hip and leg and your symptoms. Your physician normally will order an X-ray to confirm the fracture and its position. If the X-ray fails to reveal the fracture, then an MRI or bone scan may be ordered to confirm the presence of a hairline fracture.
Preparation for ORIF Surgery
Since ORIF is often employed to treat severe fractures, it typically takes place as an emergency procedure. Prior to surgery, you may have:
- A physical exam to inspect blood circulation and nerves affected by the fracture
- X-ray, CT scan, or MRI scan to assess surrounding structures and broken bone
- Blood tests
- Depending on the type of fracture you have sustained, you may be given a tetanus shot if you are not up-to-date with your immunization
- A discussion with an anesthesiologist to determine the type of anesthesia you may undergo
- A discussion with your doctor about the medications and supplements you are taking and the need to stop any
- A discussion about the need to avoid food and drink past midnight the night prior to your surgery
Treatment for Hip Fractures
Open reduction and internal fixation is a procedure most commonly used to treat severe hip fractures.
The surgery is performed under sterile conditions in the operating room under general anesthesia.
- After sterilizing the affected area, your surgeon will make a cut through the skin and muscle of the thigh.
- Your surgeon will locate the fracture by carefully sliding in between the muscles of the thigh.
- Your surgeon will put the fragments of your femur back into position (reduction).
- Your surgeon will secure the fragments of the femur to each other (fixation) by using metal plates, screws, wires, or pins.
- For a fracture in the middle of your femur, your surgeon may utilize a specially designed metal rod that passes through the middle of the bone and screws into both ends of the bone.
- Your surgeon may also carry out any other repairs if required.
- After securing the bone, your surgeon will close the incisions by suturing or staples and cover with sterile dressings.
Postoperative Care
Post procedure, you may notice significant pain and pain medication will be prescribed by your physician to keep you comfortable. You may need to take a blood thinner to prevent blood clots. To ensure that the surgery was successful, you will probably have X-rays done.
You will be given instructions on weight-bearing activities and posture management. You will be instructed about dressing and incision care. You will also be advised on diet and supplements high in vitamin D and calcium to promote bone healing. Physical therapy and an exercise regimen are suggested to restore muscle strength, flexibility, and range of motion.
Depending on your health condition and the extent of the injury, you may be able to go home the same day with scheduled follow-up appointments for monitoring progress and stitches or staples removal if required. Most people return to their normal activities within 4 to 6 months of the surgery.
Risks and Complications of Hip Fracture ORIF
As with any surgery, some of the potential risks and complications of open reduction and internal fixation of a hip fracture include:
- Bleeding
- Infection
- Blood clots
- Damage to nerves and blood vessels
- Anesthetic complications
- Hardware irritation
- Fat embolism
- Nonhealing of the fracture
- Broken hardware
