Injury to Bones and Joints: Fractures and Dislocations - Fracture of the hip



Falls are a major cause of hip fractures—the most common type of pelvic injury. Intense pain with limitation of hip movement and external rotation of the lower leg are indications of a hip fracture. When this occurs, a physician should be contacted immediately. The patient should be placed flat in bed until medical advice has been obtained. Proper diagnosis requires X-ray examinations.

Patients with hip fractures must be hospitalized. Although a hip fracture may be treated with traction, this method requires months of bed rest and is rarely used. The best method for treating such fractures is to nail the hip together with a metallic pin. The operation is performed by a surgeon, usually an orthopedist, who uses X-ray examinations during surgery to ascertain that the pin is in the correct position. Some hip fractures may also require a metallic plate screwed to the bone to help immobilize the fracture.

After plates and pins have been inserted, the patient can be out of bed within a day. This speeds recovery and prevents the complications of prolonged bed rest. Hip nails are usually left in the patient, depending on the nature of the fracture and the patient's age. Recuperation includes periodic medical checkups and X-ray examinations.

Hip Replacement

In recent years the technique of total hip replacement has become well advanced. The technique can be used where the hip joint has been injured or severely weakened by disease.

Called total prosthetic replacement of the hip , the operation involves removal of the upper portion of the large leg bone, the femur, and of the ball-like joint that holds it in the hip socket. A substitute piece shaped like the removed section of bone is attached to the femur. Care has to be taken during the operation to make certain the new part is firmly attached—by embedding the replacement part in the shaft of the bone. In addition, the surgeon tries not to destroy or damage the muscles and other tissues surrounding the hip. The replacement part is usually made of metal; a commonly used material is a durable cobalt-chromium alloy that produces no painful reactions in surrounding bones and tissues.

With modern techniques, hip replacement surgery can restore most patients to virtually normal levels of functioning. The implanted parts can carry weight and stand the strains of everyday use. Metal screws and a grouting agent (mortar of plastic cement or other material) help to join the metal implant to the leg bone. Patients may begin to walk one to three days after surgery. While they can later play golf or other nonstrenuous games, they are usually told to avoid more demanding activities, such as tennis or handball, because of the danger that they might fall and injure the replacement hip.

Some patients have had successful hip replacement surgery on both their right and left sides. Later they were able to function with good mobility and without pain.



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