Hip fractures that require fixation include those that are “intracapsular”. This means that the fracture line occurs within the hip joint itself, rather than outside the joint. When this occurs, in the correctly selected patient where the fracture has not moved much (undisplaced or minimally displaced) the hip can be fixated (“pinned”). When the fracture heals in this way, patients are often less debilitated than when other procedures on the hip are performed as all the normal bone is still present. There is a risk when fixing any of these types of fractures that the blood supply has been irreversibly damaged and this may cause a condition known as Avascular Necrosis. This causes the head to collapse as the bone dies, and usually requires a total hip replacement to be performed to avoid ongoing pain.
Fixing the fracture when the fracture line occurs outside the capsule requires different techniques. This usually requires the strength of a larger implant than when the fracture is intracapsular (inside the capsule). Often a sliding screw technique is used so when the patient walks on the injured side, the fracture can compress, speeding up the healing process. This can be done via either a dynamic hip screw which uses a plate with screws, or a nail. A nail uses minimally invasive techniques where very small skin incisions are used, and muscles are not cut. This is Dr Chien-Wen Liews preferred technique as the procedure results in less blood loss and a quicker recovery. With any hip fracture, the rate of recovery is slower than with other injuries, often due to the patient population that sustains such an injury.
Joint replacement is used in cases where the intracapsular (inside the joint) type of fracture is displaced (moved a lot) or if there is pre-existing arthritis in the hip joint. This can either be a half hip replacement (Hemiarthroplasty) or a full hip replacement (Total Hip Replacement). The decision which one should be put in is highly dependent on the patient’s own comorbidities (medical problems), their normal functional state, and their demands. Total hip replacements are becoming more common in the younger population of neck of femur fractures requiring replacement as evidence suggests that the return to function is more rapid and closer to the patient’s maximum potential. Dr Chien-Wen Liew performs total hip replacements via the direct anterior approach for most neck of femur patients treated.
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