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.
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.
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.
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.
-
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.
