Hip Fracture Follow-up

  • Author: Naveenpal S Bhatti, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Jan 13, 2012
 

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  Attending Physician, Department of Emergency Medicine, Washington Hospital, Fremont, California

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

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, and Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

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

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Genzyme Honoraria Speaking and teaching; Prostakan Honoraria Speaking and teaching; Pfizer Consulting fee Speaking and teaching

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

Disclosure: Medscape Salary Employment

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 and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

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, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

References

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  9. Canavan PK, ed. Rehabilitation in Sports Medicine: A Comprehensive Guide. Stamford, Conn: Appleton & Lange; 1998:265-6.

  10. Davison BL, Weinstein SL. Hip fractures in children: a long-term follow-up study. J Pediatr Orthop. May-Jun 1992;12(3):355-8. [Medline].

  11. Egol KA, Koval KJ, Kummer F, Frankel VH. Stress fractures of the femoral neck. Clin Orthop Relat Res. Mar 1998;348:72-8. [Medline].

  12. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. Mar 1979;61(2):216-21. [Medline]. [Full Text].

  13. Leboff MS, Narweker R, Lacroix A, et al. Homocysteine levels and risk of hip fracture in postmenopausal women. J Clin Endocrinol Metab. Jan 27 2009;epub ahead of print. [Medline].

  14. Shabat S, Nyska M, Eintacht S, et al. Serum leptin level in geriatric patients with hip fractures: possible correlation to biochemical parameters of bone remodeling. Arch Gerontol Geriatr. Mar-Apr 2009;48(2):250-3. [Medline].

  15. Zarin JS, Zurakowski D, Burke DW. Claw plate fixation of the greater trochanter in revision total hip arthroplasty. J Arthroplasty. Feb 2009;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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