What is Hip Repair?

Hip repair is a surgical procedure to repair and restore strength to the area of bone that has fractured, as well as surrounding soft tissues that may have been damaged from the injury. The procedure your surgeon performs will be based on the area of the hip that is broken and your overall health.

What is a Hip Fracture?

A hip fracture is a break in the upper quarter of the femur (the thigh bone). Hip fractures are most common in older adults or those with osteoporosis, cancer or stress injuries. The type of repair required for a hip or femur fracture depends on the extent of the break and what areas of bone and soft tissue are affected.

Hip fractures are classified as:

1. Intracapsular: which includes femoral head and neck fractures are within the joint capsule
2. Extracapsular: which includes trochanteric, intertrochanteric, and subtrochanteric fractures

Intracapsular Fracture Repair

Blood supply to the head of the femur may be damaged at the time of an intracapsular hip fracture, leading to inadequate flow to the cartilage and underlying supporting bone after repair. This can lead to inadequate healing, deformity of the femoral head, pain and difficulty walking. 

• Dependent on the degree of displacement of the fractured bones, patients may require a partial or total hip replacement. 
• Determination of treatment is based on the degree of displacement of the fractured bones, the over-all condition of the patient and even the age of the patient.
• If there is little to no displacement of the fractured bones, the fracture repair may be a hip pinning (percutaneous pinning) or involve screws and a plate to hold the bones in alignment. 

Intertrochanteric Fracture Repair

Intertrochanteric fractures – those that occur below the neck of the femur and above the shaft of the femur can be managed with either a compression hip screw or an intramedullary nail (a metal rod forced into the intramedullary cavity of the bone). 

• Both types of fixation hold the fractures together tightly which increases stability and promotes healing.
• A second screw may be placed through the nail and up into the neck and head of the femur to increase stability.

Subtrochanteric Fracture Repair

The subtrochanteric fracture occurs below the bony protuberance known as the lesser trochanter. Fractures are typically may be repaired one of two different ways:

• A long metal rod together with a large secondary (lag) screw or with screws that capture the neck and head of the femur.
• In some cases, the surgeon may use a plate that is applied to the side of the femur, rather than a rod, that is held in place with screws that go into the bone.

Surgical Hip Repair?

Surgical repair of a hip fracture will help relieve pain caused by the injury, promote a return to mobility and restore bones to their original, aligned positions. 

What Can I Expect During the Procedures?

Most hip fracture repair surgeries are performed under general or spinal anesthesia with a sedative, so you’ll be asleep during the procedure. During your surgery, the surgeon will make one or two incisions over the broken bone, move bone pieces back into their correct positions, and place screws, nails, rods and/or plates to hold the fracture in place so the bones can heal. The surgeon will then close your incisions with stitches, staples or surgical adhesive. These procedures typically take approximately two hours.

Recovery

Right after surgery, you will be less mobile than normal initially which puts you at risk of developing blood clots in your legs. To prevent blood clots physical therapy will begin to assist with mobilization and strengthening.

• Blood thinning medications will be used as well as compression devices applied to your legs to stimulate circulation when you are in bed or up in the chair. 
• You will be in the hospital for two to three days after surgery and will receive pain medication to control pain so that you can participate in physically physical therapy. You will be assisted out of bed the day of or day after surgery. Physical therapy will begin almost immediately to help you walk with a walker. 
• Depending on the severity of your injury, and your recovery progression, you may return home after your hospital stay or spend some time in a rehabilitation facility.

Estimated Recovery Timeline

A physical therapist will work with you to help you regain strength and the ability to walk on your own, which may take 3-6 months. Following hip fracture repair, most patients will regain much, if not all, of the mobility and independence they had before the injury.

Risks and Complications

Any surgery carries risks, but hip repair is typically a safe and effective procedure to treat hip fractures. You will be given instructions about how to avoid these specific risks, as well as what to do if you experience symptoms of these issues, after your hip repair procedure:

• Blood clots
• Delayed wound healing
• Infection
• Pneumonia
• Nausea/vomiting
• Constipation
• Bedsores (from being immobile)

Some long-term complications may appear months or years after surgery, but they are rare. These can include:

• Nonunion, when pieces of bone do not heal back together
• Fracture around the screws, nails or rods used to repair the bone
• Difference in leg length after healing
• Decreased blood flow to part of the bone causing part of the bone to die 

What is a Femoral Shaft Repair?

Most femoral shaft fractures require surgery. After a traumatic injury, if the skin around your fracture has not been broken, your surgeon will wait until you are stable before operating. Open fractures, however, require immediate surgery to prevent infection. A physician will place your leg in a long-leg splint to keep your broken bones aligned as you await surgery.

What Can Femoral Shaft Repair Accomplish?

Surgical repair of a femoral shaft fracture will help relieve pain caused by the injury, promote a return to mobility and restore bones to their original, aligned positions. 

External Fixation

• An external fixator is often used when there is trauma to the skin or excessive swelling after the fracture.
• In this procedure the surgeon places metal pins or screws into the bone above and below the fracture site and attaches them to a bar outside the skin. This device holds the bones in the proper position. 
• External fixation is usually a temporary treatment for femur fractures until the surrounding skin/tissue has healed or the swelling has resolved and the patient is ready for surgery to repair the break. 

Intramedullary Nailing

The most common surgical method for repairing femoral shaft fractures is intramedullary nailing. During this procedure, the surgeon inserts a specially designed titanium rod into the center canal of the femur that is called the intramedullary space as this is where the bone marrow is located. The rod passes across the fracture line to keep it in position. The surgeon can insert the rod at the hip or knee through a small incision. The rod is then fixed to the bone at both ends with screws, keeping the rod and the bone in proper position to promote bone healing.

Plates and Screws

When intramedullary nailing is not possible, such as when fractures extend into the hip or knee joint, the surgeon may use special screws and metal plates to repair the break. The surgeon will first reposition bone fragments into their normal alignment, then attach the plates to the outer surface of the bone with the screws.

What Can I Expect During the Procedures?

Most femoral shaft fracture repair surgeries are performed under general anesthesia or spinal anesthesia with sedation, so you’ll be asleep during the procedure. During your surgery, the surgeon will make one or two incisions over the broken bone, move bone pieces back into their correct positions, and place nails, screws and/or plates to hold the fracture in place so the bones can heal. The surgeon will then close your incisions with stitches, staples or surgical adhesive. These procedures typically take approximately 2 hours, depending on the severity of your injury.

Nonsurgical Femur Shaft Fracture Treatment

Typically, femur fractures must be treated with surgery. Very young children are sometimes treated with a cast. A Spica cast, which begins at the chest and extends all the way down the fractured leg, can sometimes keep the fractured pieces in the correct position until they heal. 

Recovery

You will be in the hospital for 2-3 days after surgery. To protect against blood clots, you will be given blood-thinning medication. And, you’ll be given medication to help manage your pain. Physical therapy will begin while you are still in the hospital to help you walk with a walker or crutches. 

Estimated Recovery Timeline

Most femoral shaft fractures take four to six months to heal completely, and longer if the fracture was open or broken into several pieces.

Femur Repair Risks and Complications

Any surgery carries risks, but femoral shaft fracture repair is typically a safe and effective procedure. You will be given instructions about how to best avoid these specific risks, as well as what to do if you experience symptoms of these issues, after your femur repair procedure:

• Blood clots
• Delayed union/ malalignment of bone fragments
• Delayed wound healing
• Hardware irritation (of muscles/tendons)
• Infection
• Injury to nerves and blood vessels

It’s important that femoral shaft fractures be repaired right away, as the fracture itself can cause the following complications:

• Acute compartment syndrome – when pressure in the muscle increases and impedes blood flow
• Bone infection
• Cuts/ tears in surrounding blood vessels or nerves

Learn More About Our Orthopedic Services

Baptist Health is a leading provider of orthopedic care in Kentucky and Southern Indiana. Contact an orthopedic provider at a Baptist Health facility in your area