Orthopedic Specialist for Hip & Pelvis Fractures Treatment

A hip fracture is a partial or complete break in the upper portion of the femur (thighbone), where it meets the pelvic socket (acetabulum). It is a very serious injury that needs immediate attention. These fractures commonly occur due to accidents, falls from a height, or other traumas. A stress fracture may also develop because of overuse and repetitive actions.

Most hip fractures happen to elderly people above age 60, it may happen due to a simple fall or a twist in the leg. Hip fractures are very painful, treating and bringing the patient to normal is important, as it can prevent other medical complications such as bedsores, blood clots, and pneumonia. In aged people, long bed rest can lead to disorientation which may make recovery more difficult.

Fractures in the hip cause various symptoms and complications. They are:

• Groin pain
• Inability to walk or stand
• Knee or hip pain
• Inability to lift the leg fully
• Bruising and swelling
• Visible deformity
• Lower back pain
• Stress fractures-a feeling of tendonitis or muscle strain

Sometimes any of these symptoms may occur due to other medical conditions. Therefore, always consult your doctor.

Certain short-term and long-term complications that generally occur after the injury or surgery are:

• Short term: bedsores, blood clots, and infections
• Long term: osteonecrosis, fracture non-union
• Osteoarthritis: This is common with aging, but an injury to the hip may increase the chances of developing arthritis. Symptoms include pain in the thigh, stiffness associated with pain, locking and grinding sensation while moving, decreased range of motion of the hip

Hip fractures mostly result from low or simple falls in elderly people because bones become thinner and weaker, or osteoporotic bone. When bone is lost too fast or not replaced fast enough, osteoporosis may develop and increase the risk of developing hip fractures.

Women are more affected by hip fractures than men due to low bone density that occurs after menopause (estrogen level falls). As a result, 70% of women experience hip fractures.

Certain medical conditions can also raise the risk of fractures:

• Gastrointestinal, metabolic, and nutrition disorders. These conditions will lead to vitamin D or calcium deficiency that causes weaker bones
• Neurologic conditions such as dementia and balance disorders. Due to this, the person may fall and a fracture may cause

Preventing a hip fracture is better than treating a fracture.

• Consume enough vitamin D and calcium-rich foods like milk, cottage cheese, yogurt, and broccoli
• Getting a bone density test, if you have a risk of developing osteoporosis
• Exercise regularly such as walking or jogging
• Stop smoking and drinking
• Stand up slowly will help you avoid light-headedness or loss of balance
• Keep the place without hazards
• Place slip-resistant mats near bathroom doors
• Keep bed lamps for elders to lead them from bedroom to bathroom
• Check your vision

A fracture in the hip could be a single break or multiple breaks. To understand the complete medical history, the doctor may conduct diagnostic tests such as:

• X-ray
• MRI scans
• CT scans

Your doctor may ask you to get an osteoporosis test if you break your hip, which may help to take preventive steps from causing another fracture.

Treatments for hip fractures include a combination of pain control, surgery, and rehabilitation.

• Pain control: after the fracture, the doctor will give medications and injections to control the pain.
• Surgery: surgery is the best method, in general, to reduce the symptoms and avoid complications of long bed rest.
• Surgical methods include: Open reduction and internal fixation (ORIF), Femoral head or total hip replacement (arthroplasty or hemiarthroplasty).
• Alternative methods: for most of them, surgery is recommended, but surgery may not be correct for people who are frail to recover. Some are treated with medications and bed rest.

Avascular necrosis is the death of bone tissue that is caused due to the loss of blood supply to the bone. If it is untreated or undiagnosed, it can lead to tiny breaks in the bone and can become fragile and may collapse. This is called osteoarthritis.

Avascular necrosis happens near any joint, typically affects the hip, it can occur in the shoulder, knee, elbow, wrist, foot, or ankle. It is mostly seen in the ends of a long bone. It may affect one or many bones at a time or at different times.

Avascular necrosis might have been caused due to :

• Injury or fracture
• Fatty deposits in blood vessels that block the small blood vessels, reducing the blood flow that feeds bones
• Certain chronic medical conditions

The symptoms of avascular necrosis are similar to other medical conditions or bone problems. However, every person may experience different symptoms:

Many people do not have any symptoms at the early stages of avascular necrosis. As the condition progresses, the affected joint may get hurt when weight is put on it, which gives pain even when the person is lying down. Pain associated with avascular necrosis of the hip may center on the groin, thigh, or buttock. Some people may develop avascular necrosis on both sides of the hip or knees.

Risk factors for developing avascular necrosis are:

• Trauma
• Long term medication
• Excessive alcohol use
• Bisphosphonate: long-term use of this medicine for increasing bone density may develop osteonecrosis in the jaw. This rare complication occurred in some people who are treated with high doses of these medicines for cancers such as multiple myeloma and metastatic breast cancer.
• Medical treatments such as radiation therapy for cancer, organ transplantation like kidney transplants may also cause avascular necrosis.

Medical conditions associated with avascular necrosis include:

• Pancreatitis
• Diabetes
• Gaucher's disease
• HIV / AIDS
• Systemic lupus erythematosus
• Sickle cell anemia

The doctor will check your medical history and may perform one or more tests, including

• X-ray
• CT scan
• MRI
• Radionuclide bone scan
• Biopsy
• Functional evaluation of the bone

The treatment for avascular necrosis is planned by the doctor based on:

• Your age, health, and medical history
• The severity of the disease
• Area and amount of bone affected
• The underlying cause of disease

The treatment aims to improve functionality and stop further damage to the bone or joint.

In the early stages of the condition, the symptoms may be eased with medicines and therapy such as,

• Nonsteroidal anti-inflammatory drugs
• Osteoporosis drugs
• Cholesterol-lowering drugs
• Blood thinners
• Rest
• Exercises
• Electrical stimulation

Many do not develop symptoms until avascular necrosis is advanced. The surgery options include:

• Core decompression: A part of the inner layer of your bone is removed. Besides reducing the pain, the extra space within your bone stimulates the production of healthy bone tissue and new blood vessels.
• Bone transplant (graft): This surgery will strengthen the area of bone affected by avascular necrosis. The graft is a part of a healthy bone taken from another part of your body.
• Bone reshaping (osteotomy): A wedge of bone is removed above or below a weight-bearing joint; this will help in shifting your weight from the damaged bone. Bone reshaping might enable you to postpone joint replacement.
• Joint replacement: If the bone has collapsed or other treatments aren't helpful, then you may need surgery to replace the damaged parts of your joint with plastic or metal parts.
• Regenerative medicine treatment: A new procedure that is introduced to treat early-stage avascular necrosis of the hip is bone marrow aspirate and concentration. In this, stem cells are harvested from the bone marrow. During the procedure, a core of dead hip bone is replaced with stem cells that allow the growth of new bone.

The acetabulum is a cup-like depression on the lateral aspect of the pelvis, which articulates with the head of the femur to form the hip joint. The acetabulum is formed from parts of the ilium, ischium, and pubis bones. The acetabulum fracture is a fracture in the socket portion of the ball and socket hip joint. These fractures are less common than those that involve the femoral head, or the ball of the joint.

Acetabulum fractures are caused due to high-energy accidents like a car collisions. These breaks or fractures of the pelvis or acetabula of the hip joint are the most serious injuries treated by orthopedic surgeons. At times, elderly people having fragile bones due to osteoporosis may develop pelvic or acetabulum fractures even from a low-impact fall.

Acetabular fractures may vary in size, location, and severity. The bone may break straight across the acetabulum, or it may even shatter. When a fracture occurs, the femoral head may not fit in the socket properly and it may result in damage to the cartilage surface of both bones.

The severity of the injury depends on various factors such as:

• The number and size of the fractures
• The amount of displacement of each fractured piece
• Damaged happened to the cartilage surfaces of both acetabulum and the head of the femur
• The injury to the surrounding tissues such as tendons, muscles, nerves, and skin

The fracture always causes pain due to the large size of the joint and how much weight it bears daily. The pain may get worsened while moving.

If a nerve gets damaged in the injury, there could be numbness, weakness, or tingling sensation down the leg.

These fractures are caused due to force that occurs due to accidents. Depending upon the direction of the force, the head of the femur may get pushed out of the hip socket. This is called hip dislocation.

If the fracture is due to a high energy impact, then the person will have extensive bleeding and also associated injuries that may need immediate medical care.

This type of fracture may also be caused due to osteoporosis which is more common in older people.

Patients who have met accidents are admitted to the emergency room for initial treatment because of the severity of the condition. The accident might have caused other injuries to the head, chest, abdomen, hands, or legs. If there is a high amount of blood loss, then it may also result in organ failure.

Physical examination- in the emergency room, the doctor will examine the pelvis, hips, and legs and see if the person can move ankles and toes and feel any sensation on the bottom of the feet. In some cases, nerves may be injured. The doctor will carefully check if there are any other injuries in the body.

Imaging tests such as X-rays, CT scans are performed to check the number of fractures and to know if there is any displacement of the bones.

Many things are taken into consideration before planning the treatment, including,

• The pattern of the fracture
• Displacement of the bones
• Health condition of the patient

Non-surgical treatment: Nonsurgical treatment is recommended for patients whose bones are not displaced, and for patients who are at higher risk for surgical complications.

Nonsurgical treatments are:

• Walking aids such as crutches
• Positioning pads are suggested if the doctor is concerned about the stability of the joint
• Medications

Surgical treatment: Most of the acetabular fractures are treated with surgery. The objective of the surgery is to restore a smooth hip cartilage surface for painless movement.

The surgery involves restoring the anatomy of the hip joint that is refitting the femoral head into the hip socket.

These surgeries are very complicated; therefore, the surgeon will not carry out the surgery immediately. The doctor will delay for few days to ensure if the overall health condition is stable to undergo surgery.

Recovery: The recovery period for these fractures may take a long time up to 12 months. The results might vary for every patient depending on the factors like:

• The severity of the fracture
• Other injuries occurred in the accident
• Age and bone quality
• Health condition of the person if he has a habit of smoking then healing of the bone may slow down and increase the complications

After a successful surgery, some patients might experience certain complications that may lead to additional surgery:

• Infections
• Blood clots
• Posttraumatic arthritis
• Sciatic nerve injury
• Heterotopic ossification
• Avascular necrosis

The hip is among the most critical joints in the body. A ball-and-socket joint is utilized. The acetabulum, a component of the larger pelvic bone, forms the socket. The sphere is the femur head, which would be the femur's upper end (thighbone).

Hip arthritis is when the cartilage in the hip joint wears out or is destroyed, causing the bone surface of the joint to rub together and become gritty. This produces discomfort and tightness, making it hard to move the limb.

There are many varieties of hip arthritis, but they all entail the degradation of cartilage inside the hip joint, which ultimately leads to bone grinding on bone and deterioration of the joint.

Signs that you might have the arthritis of the hip:

• Pain in the crotch or thighs that spread to the knee, outer thighs or buttocks
• Limping or soreness that causes difficulty moving
• Locking or freezing of the hips at the socket
• Increasing pain in rainy conditions
• Joint stiffness could be more evident in the morning or after being idle
• The joint might feel sore when you put light pressure on it or near it
• There is a lack of flexibility. You might not even be able to extend your joint throughout its complete range of motion.
• These different fragments of bone that feel like rough lumps might grow around the damaged joint
• Swelling could be induced by soft tissue irritation around the joint

Arthritis may be caused by numerous circumstances, including ordinary wear and tear, inflammatory illnesses including lupus and rheumatoid arthritis, infection or trauma. This fluctuates based on your body weight, level of activity and the anatomy of your hip joint.

One of the causes could be the anatomic anomalies that exert tension on the joints, resulting in premature cartilage degeneration, such as hip impingement and hip dysplasia.

The eventual effect of all these events is a breakdown of the cartilage in the hip joint, resulting in bone-on-bone friction in the hip. Nonetheless, the level of pain and disability symptoms in patients with arthritis varies substantially.

Risk factors for having hip arthritis are:

• Some forms of arthritis occur in the family, so you may be particularly likely to acquire arthritis if one or more of your parents or relatives have the illness.
• The risk of several kinds of arthritis rises with age.
• Women are generally more prone than males to acquire arthritis, but most individuals with gout, a type of arthritis, are usually men.
• People who have damaged a joint, maybe while playing sports, are more prone to developing arthritis in that joint.
• Carrying additional weight puts pressure on joints, notably the knees, hips and back. Overweight people have a greater risk of acquiring arthritis.

Persistent arthritis, especially if it involves the hands or arms, may make it extremely challenging for you to conduct daily duties. Arthritis of weight-bearing bones can prohibit you from moving correctly or sitting up straight. Sometimes, joints may start losing their placement and shape.

If you fear you might have arthritis in your hip, one of the most critical first steps is an official diagnosis.

• Your health records will be viewed, particularly if you have discomfort or if you limp sometimes.
• A physical examination will be done to see, in particular, how effectively you can move the hip.
• Radiographs or X-rays will be used to identify if there are any anomalies in the joint.
• Blood tests to discover antibodies connected with a specific form of arthritis will be taken but only if needed.

Your doctor will recommend the form of treatment suitable for your specific type of arthritis and other considerations, like your general health, age, and individual preferences.

Non-surgical Treatments:

• Administering anti-inflammatory drugs, like ibuprofen
• Receiving corticosteroid injections to suppress the swelling in the joint
• Exercise routines or physiotherapy to improve flexibility, build muscular endurance, and maintain muscle tone
• Making lifestyle changes like maintaining your weight and reducing activities that stress your joints are essential

Surgical Treatments:

• A total hip replacement could be recommended if the hip joint is significantly injured
• Osteotomy surgery could be suitable in less severe instances. Only a restricted set of individuals are eligible for osteotomy surgery

The pelvis is shaped like a basin that sustains the spinal cord and shields the abdominal organs. The pelvis is a complete structure created by the sacrum, two hip bones, and the coccyx attached below the sacrum. The associated hip bones are the big, curved bones that create the anterolateral sides of the pelvis.

A pelvic fracture is a breakage in any one of those bones. Some pelvic fractures include shattering more than one of several bones, and these are especially severe as the bones are much more likely to move out of line.

Pelvic fractures are characterized as stable or unstable. The fracture is stable when the pelvis has one break site in the pelvic ring, and the bones are kept in place with minimal bleeding. It is unstable if two or even more breaks in the pelvic ring with mild to severe bleeding.

The primary sign of a pelvic fracture is discomfort in the crotch, hip or lower back, which might worsen when moving or extending the legs. Additional symptoms may include:

• Experiencing abdominal discomfort
• Difficulty moving or standing up
• Numbness and tingling are experienced in the crotch area or legs
• Bleeding from the vagina, urethra (the tube that takes urine from the bladder to the outside of the body) or rectum (the chamber that stores solid wastes from the large intestine until they are discharged outside the body)
• Trouble urinating
• Bruising around the pelvic bones themselves
• Bruising or a sensitive bump in the crotch or even on the perineum
• Experiencing discomfort in the middle of the back

Sometimes any of these symptoms may occur due to other medical conditions. Therefore, always consult your doctor.

The seriousness of a pelvic fracture varies depending on how many bones are shattered and what injuries may have happened to the organs within the pelvis. Pelvic fractures, therefore, differ significantly in severity, from somewhat mild to life-threatening.

• Severe pelvic fractures occur from traumatic injuries such as road accidents, crushing injuries (for example, getting run over by a car or trampled on by a horse) or falling from heights. When induced by high or high-speed traumas, the fractures are often unpredictable and usually need immediate hospital care.
• Less severe fractures, which include undisplaced fractures, can develop following slips or falls, especially if the bones are weak due to osteoporosis. For this reason, severe but steady fractures are more prevalent in elderly individuals who seem to have "relatively thin" bones and are often prone to falls.

Factors that increase the risk of a pelvic fracture are:

• Sportspersons
• Individuals who have weak bones, usual people with osteoporosis
• Decreased muscular strength
• Older individuals

Severe injuries to the pelvis, which include many fractures, can be life-threatening. After such a pelvic fracture, there could be injuries to organs inside the pelvic ring like the intestines, bladder, kidneys, or genitals. A minor fracture is generally treated using bed rest and medicines.

The doctor may ask about complaints and previous health. A health assessment will be done. Tests like blood and urine tests might also be done.

Imaging examinations of the area may be conducted to checak for injuries in the region. They may include:

• X-ray
• Ultrasound
• CT scans
• Urethrography as well as cystography, which are urinary tract images
• Angiography

The treatment for these fractures varies depending on how severe the injury is.

The most basic treatment with a minor fracture is resting or complete bed rest, nonsteroidal anti-inflammatory drugs or prescription painkillers. Physical therapy, the use of splints and, occasionally, surgery may be an option.

Unstable fractures will necessitate surgery. Options are:

• An external fixation mechanism to retain the bones in place. Screws are put through the bone to a cage outside the pelvis.
• In some cases, pins, bolts, or plates are put within the bones to hold them in place.

Treatment will also include:

• Medications that alleviate pain and prevent blood clots are available
• Bed rest—to aid in bone repair
• Physiotherapy to maintain bone and muscle function

Recovery can take four weeks to several months. It relies on how bad the injuries are. Many fractures occur due to accidents. Some could be prevented with sufficient precautions.