Introduction
Hip fractures are surgically repaired with a special type of metal plate and screw, called a compression screw, for a couple of reasons. First, it helps align the bone fragments and hold them in the proper position. Second, the fixation device is strong enough to keep the bones in place as you begin to move about. Before these devices were used, a patient needed to remain in bed usually with traction to hold the bones in alignment. The fixation now holds the bones in place while the bone heals. This allows you to get out of bed sooner because the metal plate and screw are strong enough to hold the bone fragments in place as you move.
The procedure requires a small incision on the side of the hip, and the plate and screw usually provide a solid connection for the broken bones. Since patients are able to get moving right away after surgery, they are more likely to avoid the serious complications that can arise with being immobilized in bed.
Surgical Procedure
Compression hip screw fixation can be an involved surgery with several fragments of bone needing to be held together. There may also be substantial blood loss during surgery, which could require you to have a blood transfusion during the operation.
This operation can be done using either a general anesthetic or a spinal block. A general anesthetic puts you completely to sleep. A spinal block puts your body to sleep only from the waist down. The anesthesiologist will also give you medications so that you won’t be aware the operation is being done.
Once you have anesthesia, your surgeon will make sure the skin of your hip is free of infection by cleaning the skin with a germ-killing solution.
With the patient lying flat on a special table, the foot and leg are supported and the fractured bones are lined up. The surgeon checks the alignment using a fluoroscope, a type of X-ray machine that shows the image on a TV screen.
Next, the surgeon makes an incision over the side of the thigh. A large metal screw is placed through the side of the hip into the top of the thighbone (femoral head). With the help of the fluoroscope, the surgeon attaches a metal plate to the side of the thighbone (femur) with four to eight small metal screws. The procedure can usually be finished in less than an hour depending on how many fragments of bone are involved in the fracture.
The soft tissues are put back in place, and metal staples or sutures are used to close the incision.
Complications
Common complications after a hip fracture are sometimes the result of being immobilized in bed. These may include pneumonia, bedsores, mental confusion, and blood clots (deep vein thrombosis).
Complications that can result from the compression fixation surgery itself include infection, nerve or blood vessel injury, or nonunion of the bones.
This is not intended to be a complete list of possible complications.
After Surgery
Your hip will be covered with a padded dressing. If your doctor used a general anesthesia, a nurse or respiratory therapist will guide you in a series of breathing exercises. You’ll use an incentive spirometer, a breathing exerciser to help improve your breathing and avoid possible problems with pneumonia.
A physical therapist will direct your recovery after surgery. You’ll be encouraged to move from your hospital bed to a chair several times the first day after surgery. You’ll be encouraged to begin getting up and walking with your crutches or walker, but you may need to avoid placing too much weight on your foot while you stand or walk. You’ll be ready to go home when you can move about safely with your walker or crutches, are able to do your exercises, and your caregiver has made all the necessary preparations for you at home.
Rehabilitation
Home Health Needs
Once discharged from the hospital, you may see a therapist for one to six in-home treatments. This will help to ensure your safety in and about the home and getting in and out of a car. Your therapist will make recommendations about your safety, review an exercise program, and continue working with you on walking and strength. In some cases, additional visits at home may be required before beginning outpatient physical therapy.
Outpatient Physical Therapy
Additional outpatient physical therapy visits are sometimes needed for patients who are still having problems walking or who need to get back to physically heavy work or activities.
A therapist may use hands-on stretches for improving range of motion. Strength exercises address key muscle groups including the buttocks, hips, and thighs.
Therapists sometimes treat their patients in a pool. Exercising in a swimming pool puts less stress on the hip joint, and the buoyancy makes movement and exercise easier. An independent program may be assigned once the therapist has taught you come pool exercises.
When it is safe to put full weight through the leg, several types of balance exercises can be chosen to further stabilize and control the hip. Finally, a select group of exercises can be used to simulate day-to-day activities, such as going up and down steps, squatting, and walking on uneven terrain. Specific exercises may then be chosen to simulate work or hobby demands.
The therapist’s goal is to help patients maximize hip range of motion and strength, restore a normal walking pattern, and safely participate in certain activities. When patients are well underway, regular visits to the therapist’s office will end.
