A broken hip in an elderly person is a serious medical event that almost always requires surgical intervention for optimal recovery and mobility. Given the complexities of treating older patients, which often include osteoporosis and other comorbidities, the orthopedic surgeon tailors the surgical approach to the individual's specific needs. The main goal of surgery is to reduce pain and allow for rapid mobilization and rehabilitation. The procedure chosen is typically a form of internal fixation or a hip replacement, also known as arthroplasty.
Internal Fixation (Hip Pinning or ORIF)
Internal fixation is a common method for repairing hip fractures, especially for certain fracture types where the bone's blood supply is not compromised. The procedure involves surgically realigning the broken bone fragments and securing them with specialized hardware to hold them in place while the bone heals. This process is also known as Open Reduction and Internal Fixation (ORIF).
Types of Internal Fixation Hardware
- Sliding Hip Screw and Plate: Used for intertrochanteric fractures, this involves a large screw placed into the head of the femur, connected to a side plate along the thigh bone. This device allows for controlled compression at the fracture site, promoting healing.
- Intramedullary Nail: This is a rod inserted directly into the marrow canal of the femur. It is particularly effective for unstable trochanteric and sub-trochanteric fractures. Screws are placed through the nail and into the bone to provide stability.
- Cannulated Screws: For undisplaced or minimally displaced femoral neck fractures, surgeons may use parallel screws or pins to hold the bone together. This is a less invasive procedure than other fixation methods.
Hip Replacement (Arthroplasty)
Hip replacement, or arthroplasty, involves removing the damaged parts of the hip joint and replacing them with artificial components (prostheses). This option is often preferred for older patients with displaced femoral neck fractures, as these injuries can disrupt blood flow to the femoral head, increasing the risk of the bone dying (avascular necrosis).
Types of Hip Replacement
- Partial Hip Replacement (Hemiarthroplasty): In this procedure, only the ball of the femur (femoral head) is replaced, leaving the natural socket (acetabulum) intact. It is often recommended for elderly individuals with significant displacement or other health conditions that may complicate a total replacement.
- Total Hip Replacement (Total Hip Arthroplasty or THA): This more comprehensive procedure replaces both the femoral head and the hip socket with artificial parts. It is often chosen for more active, independent elderly patients or those with pre-existing arthritis in the injured hip.
Comparing Hip Fracture Surgical Options
| Feature | Internal Fixation (ORIF) | Partial Hip Replacement (Hemiarthroplasty) | Total Hip Replacement (THA) |
|---|---|---|---|
| Best For | Stable or minimally displaced fractures, particularly in the intertrochanteric region. | Displaced femoral neck fractures in less active elderly patients or those with comorbidities. | Active, independent elderly with displaced femoral neck fractures or pre-existing arthritis. |
| Procedure | Realignment of broken bone, secured with screws, plates, or rods. | Replaces only the femoral head with a prosthesis. | Replaces both the femoral head and the hip socket with prostheses. |
| Recovery | Often involves restricted weight-bearing for several weeks; can take longer to achieve full mobility. | Allows for earlier weight-bearing and quicker mobilization compared to fixation. | Allows for immediate mobilization and often leads to the best long-term function. |
| Healing Risk | Risk of non-union (failure to heal) or avascular necrosis, especially with displaced femoral neck fractures. | Lower risk of non-union or avascular necrosis compared to fixation. | Very low risk of non-union, provides a more stable long-term solution. |
Factors Influencing the Surgical Choice
Several factors play a role in the decision-making process for which surgery is best for an elderly patient with a broken hip.
- Fracture Location and Type: Intra-capsular fractures of the femoral neck often require replacement due to blood flow issues, while extra-capsular fractures in the trochanteric area are typically treated with internal fixation.
- Bone Density: Elderly patients often have osteoporosis, which can affect the holding power of screws and plates, sometimes making a hip replacement a more reliable option.
- Overall Health and Mobility: The patient's pre-fracture mobility, cognitive status, and existing medical conditions are critical. An active, healthy senior might benefit most from a total hip replacement, while a less active patient might be better suited for a partial replacement or fixation.
Conclusion
Surgery for a broken hip in the elderly is not a single procedure but a tailored medical approach based on the specifics of the fracture and the patient's overall health. From internal fixation with pins and screws to partial or total hip replacement, the goal is consistent: to restore function, minimize pain, and facilitate a return to mobility. A thorough evaluation by an orthopedic surgeon is essential to determine the most effective treatment plan, leading to the best possible long-term outcome. Advances in surgical techniques and post-operative care continue to improve recovery times and reduce complications for older adults. [https://www.ncbi.nlm.nih.gov/books/NBK565572/] for further reading on surgical options for hip fractures.
