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Hip Fracture Follow-up

  • Author: Naveenpal S Bhatti, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Jan 22, 2015
 

Return to Play

As may be expected, each athlete with a hip fracture is treated on an individual basis. To return to play, the athlete should be off all pain medications, be relatively pain free, and have no return of symptoms during sports-specific activities.

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Complications

Complications related to poorly treated or misdiagnosed stress fractures are considerable. AVN, nonunion, varus deformity, chronic pain, and completely displaced femoral neck fractures may occur and may lead to serious life-altering changes in function and the patient's ability to ambulate efficiently.

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Prognosis

The prognosis for hip fractures is dependent on the age and condition of the patient and on the location and type of fracture. Athletes who sustain femoral neck stress fractures may or may not be able to return to their sport. Tension stress fractures are generally unstable and have an unfavorable prognosis. On the other hand, compression fractures are usually successfully treated with conservative measures and have a good prognosis for recovery. Hip fractures in elderly individuals have a mortality rate of 14-36% one year following surgery.

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Patient Education

Patient education is a very important aspect to the rehabilitation process following hip fracture, regardless of the patient's age. Patients must be thoroughly informed about treatment options following their diagnosis, and they must understand the benefits and risks of treatment. If conservative treatment is an option, the patient may need instruction in the use of crutches initially to restrict weight bearing. A physical therapist should be involved in the patient's care for instructions in mobility training and reconditioning of the affected lower extremity. Patients are usually instructed in a home exercise program for continuing strengthening of the hip so that they are able to return to their previous level of activity.

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Contributor Information and Disclosures
Author

Naveenpal S Bhatti, MD Consulting Staff, Department of Emergency Medicine, Hayward/Fremont Medical Centers

Naveenpal S Bhatti, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Institute of Ultrasound in Medicine, North American Spine Society, International Spine Intervention Society, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.

References
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  18. Zarin JS, Zurakowski D, Burke DW. Claw plate fixation of the greater trochanter in revision total hip arthroplasty. J Arthroplasty. 2009 Feb. 24(2):272-80. [Medline].

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A subcapital femoral neck fracture. Slight compression of the femoral head onto the femoral neck can be seen. Note the cortical break medially. This fracture could be missed if not closely evaluated.
A view of the contralateral hip for comparison.
Intraoperative x-ray film (fluoroscopic view) of placement of the lag screw.
Addition of a superior derotational screw to maintain alignment and allow compression.
Internal fixation of the subcapital femoral neck fracture with a screw and short side plate with an additional derotational screw above. Final anteroposterior view.
Garden I femoral neck fracture. Note the valgus impaction with compression of the superior femoral head-neck junction.
Lateral view of a Garden I femoral neck fracture. Compression of the head-neck junction inferiorly.
Anteroposterior view of the pelvis with a displaced femoral neck fracture.
Lateral view of a displaced femoral neck fracture.
Displaced femoral neck fracture treated with a conventional, noncemented monopolar hemiarthroplasty.
Lateral view of a unipolar hemiarthroplasty.
An example of a calcar replacement hemiarthroplasty. A low femoral neck fracture extending into the calcar femoralis, not amenable to internal fixation or conventional hemiarthroplasty, requiring a calcar replacement prosthesis.
A lateral x-ray film of a calcar replacement hemiarthroplasty.
 
 
 
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