Treatment for Hip Fractures: Non-Surgical & Surgical Versions

When it comes to treating hip fractures, doctors can use two methods, depending on the nature and gravity of the fracture—non-surgical and surgical. On this page, let us discuss the best non-surgical and surgical treatments. [ref]

Non-Surgical Treatments

You may be advised by your physician to avoid bearing any weight on the injured hip for at least six weeks following a hip or pelvic fracture. This permits the bone to recover. For mobility assistance, your doctor may prescribe a wheelchair, a cane, a walker, or crutches.

Despite the injuries, you should continue to be active because prolonged immobility might weaken your muscles. In addition, a lack of activity might result in deep vein thrombosis, which is a blood clot that blocks blood flow in the leg. [ref]

To keep your muscles and joints strong and increase blood flow, which promotes healing, your doctor might suggest range-of-motion and stretching exercises for muscles and joints other than the injured hip.

Bone Stimulation Using Electronics & Ultrasonic Waves

To hasten bone healing, your physician can suggest a method known as bone stimulation. Low-intensity pulsed sound waves or a mild electric current are used for bone stimulation.

Your doctor might also suggest a portable device that you can use every day at home if your fracture is taking a long time to heal.

Tiny electrodes —flat discs that stick to the skin and carry electricity—are applied to the skin close to the fractured hip or pelvic bone by a physician during electronic bone stimulation. A machine that delivers a little electrical current to the afflicted bone is linked to the electrodes. By encouraging your body to make proteins that start repairing cells at the site of the injury, this method speeds up the healing process.

A little machine creates ultrasonic sound waves, which are then conducted by a gel that a doctor puts on the skin during ultrasonic bone stimulation. In addition to promoting the creation of specific molecules involved in the healing process, sound waves help the body integrate calcium into the bone, assisting in the reconstruction of bone mass.

Physical Therapy

A physical therapist can teach you exercises to help maintain the strength and range of motion in the joints and muscles surrounding the broken hip or pelvic bone once it has started to mend. For example, leg lifts and hamstring stretches can help keep muscles from stiffening or weakening while you avoid bearing weight on the fractured hip.

A fracture may also heal more quickly with physical therapy than with immobilisation alone. Exercise promotes blood flow, which helps broken bone sections repair by supplying them with more oxygen and nutrients.

After the bone has healed and you can walk normally again, doctors frequently advise extra physical treatment to strengthen the muscles in your legs, back and abdomen. Muscles that were immobile during the bone's healing process can become more flexible with physical therapy. Additionally, it can aid in the hip joint's range of motion restoration.

The duration of therapy is decided by your physician and physical therapist. How long you kept your weight off your hip and the location and severity of the injury will determine this.

Medication for Pain Alleviation 

Hip fractures can cause excruciating pain. As the fracture heals, your doctor may recommend using pain medication to help you feel more comfortable. Some people react well to over-the-counter drugs, such as paracetamol.

If over-the-counter medications do not effectively relieve your pain, your doctor may recommend a stronger prescription for one or two weeks to help you get through the early healing phase and the beginning of physical therapy.

Steer clear of nonsteroidal anti-inflammatory medications.

Your doctor might advise against taking nonsteroidal anti-inflammatory medicines (NSAIDs) while a fracture is mending. These drugs reduce pain by decreasing inflammation at the site of an injury. NSAID use following a hip or pelvic fracture may slow bone healing, albeit inflammation plays a significant role in the body's healing process.

Surgical Treatment

Scheduling an Appointment

Restoring hip function, reducing discomfort, and enabling you to resume your daily activities are the objectives of the surgery. Based on your age, the position, extent and type of the injury, the reason for the fracture, and whether any underlying medical conditions—like osteoarthritis or osteoporosis—may have an impact on the result, they choose the best surgical technique as part of the treatment.

Surgery for Reduction and Fixation

For a fractured hip or pelvic bone to mend completely, it must be set and stabilised. The act of setting the bone or putting the pieces of bone back together is called reduction. Fixation is a process that joins bone fragments into a single, solid bone while preventing them from moving while new bone tissue forms.

Both Closed and Open Reduction

A surgeon may choose to perform an open reduction or a closed reduction, depending on the location and severity of the fracture.

Closed Reduction 

A less intrusive technique called a closed reduction involves the surgeon making tiny incisions close to the fractured bone and then using surgical tools to put the pieces of bone back together. For minor fractures with few bone fragments and no skin breakage, closed reduction might be suitable. A closed method could hasten healing and reduce harm to nearby soft tissues.

Open Reduction

An open reduction allows the surgeon to examine the shattered bone fragments and determine how well they can be reassembled by making an incision over the affected area. For open fractures, where a bone penetrates the skin, open reduction is necessary. When shattered bones are broken into numerous fragments and some of the fragments are displaced or out of position, this method is also required. When bone pieces are too tiny to be removed, open reduction is employed. If doctors were unable to put bone pieces back together in the proper location after a closed reduction, they might have to do this treatment.

Internal and External Fixation

After the fractured bone has been reduced, a surgeon uses one or more fixation devices to 

keep the bone fragments in position while the bone heals. Most of the time, surgeons use internal fixation, a technique involving stainless steel screws, plates, wires, and rods to permanently fix the bone fragments together.

The surgeon determines the most appropriate fixation device depending on the location and severity of the fracture.

The surgeon may use an external fixation device to stabilise the bone if violent, potentially fatal accidents, like an automobile collision, are the causes behind the fracture. This frees up medical professionals to concentrate on fixing internal organs, blood vessels, and nerves. In order to permanently fix the bone fragments in place, surgeons may later carry out further surgeries.

Surgeons insert metal pins into the bones on each side of the hip or pelvic fracture, then attach the pins to a frame that extends outside the body during external fixation. By connecting any missing pieces, this frame keeps the bones stable.

Only fractures that are accessible from the front of the body are treated with this kind of external brace. Surgery utilising various fixation techniques is necessary for a fracture at the posterior of the pelvis.

Hip Replacement Surgery

If the hip fracture has caused the joint to become so badly damaged that reduction and fixation are not adequate to stabilise the bones, doctors may recommend a procedure to replace the damaged ball and socket components of the joint with durable prosthetic pieces, usually made of metal or ceramic. It is more common to recommend partial or total hip replacement for patients with significant femur fractures that cannot be repaired.

Before surgery, you are given either spinal or general anaesthesia. The surgeon creates an incision at the front, side, or back of the hip to gain access to the joint. He or she removes the injured surface of the spherical femoral head and the socket-shaped acetabulum, together with any loose pieces of cartilage or other tissue.

After placing the prosthetic components, the surgeon sutures the incision shut. To help manage pain following the treatment, doctors inject painkillers into the hip's surrounding tissues.

What to anticipate following surgery for hip replacement? 

Your physical therapist keeps an eye on your recovery and assists you in walking with your new hip. Experts in pain management recommend medicine to keep you comfortable as your body recovers.

When you can move around enough to carry out everyday tasks independently, you can return home. Your recovery time will determine whether that occurs on the same day as the surgery or one to three days later.

The physical therapists help you rebuild muscle and give you exercises to improve your hip range of motion and flexibility once you are able to walk pain-free and without assistance. To condition and strengthen your muscles, our physical therapists and rehabilitation specialists design an exercise program that you may follow at home. 

Physical therapy is typically prescribed by our doctors for six to twelve weeks. They then evaluate your progress to see if you require further physical therapy.