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Treatments and drugs
By Mayo Clinic staff
Treatment for hip fracture often involves a combination of three approaches, including:
- Surgery
- Rehabilitation
- Medication
Surgery
Surgery is almost always the best hip fracture treatment. Doctors typically use nonsurgical alternatives, such as traction, only if you have a serious illness that makes surgery too risky.
The type of surgery you have generally depends on the part of the hip that fractured, the severity of the fracture and your age. Generally, the better your health and mobility before your hip fracture, the better your chances for a complete recovery from a hip fracture.
Femoral neck fractures
Doctors repair this type of fracture by one of three methods:
- Metal screws. If, after the break, the bone is still properly aligned, your doctor may insert metal screws into the bone to hold it together while the fracture heals. This is called internal fixation. Often metal screws are placed in combination with bone nails (gamma nails) for additional stability.
- Replacement of part of the femur. If the ends of the broken bone aren't properly aligned or they've been damaged, your doctor may remove the head and neck of the femur and replace them with a metal prosthesis. This is known as hemiarthroplasty.
- Total hip replacement. This procedure involves replacing your upper femur and the socket in your pelvic bone with prostheses. Total hip replacement may be a good option if arthritis or a prior injury has damaged your joint, affecting its function prior to the fracture.
Although older age increases the likelihood that you'll need hip replacement, the most significant factors in determining whether you need this procedure are:
- The type of fracture you have
- The severity of your signs and symptoms
- Your personal risk of surgery-related problems
- Your mobility and ability to function independently before the fracture
Intertrochanteric fractures
To repair this type of fracture, your doctor usually inserts a metal screw (hip compression screw) across the fracture. The screw is attached to a plate that runs down alongside the femur. This plate is attached with other screws to help keep the bone stable. As the bone heals, the screw allows the bone pieces to compress, so the edges grow together.
Depending on the type of fracture, your doctor may first place a bone nail (gamma nail) down the shaft of your bone, and then pass compression screws through the nail. The nail helps prevent sliding and provides additional stability, and it may enable you to bear weight earlier.
Rehabilitation
If you're having a normal recovery from surgery, the next steps will likely follow this schedule:
- Within about 1 day after surgery. Your care team will help you get up and moving, often with the help of a walker. You'll begin physical therapy, typically with a focus on range of motion and strengthening exercises.
- Within about 1 week after surgery. Hospital stays after hip fracture surgery generally last less than a week. Depending on the type of surgery you had and whether you have assistance at home, you may need to go from the hospital to an extended care facility.
- Within 1 month after surgery. In extended care and at home, you may work with an occupational therapist to learn techniques for independence in daily life, such as using the toilet, bathing, dressing and cooking. Your occupational therapist will determine if a walker or wheelchair may help you regain mobility and independence.
Ongoing, you may continue to meet with a physical therapist and occupational therapist as you recover from surgery.
Medication
While surgery is the primary treatment for a hip fracture, a group of bone density-enhancing medications called bisphosphonates may help reduce the risk of a second hip fracture. Most of these drugs are taken orally and are associated with side effects that may be difficult to tolerate, including nausea, abdominal pain and inflammation of the esophagus. As an alternative, one bisphosphonate, zoledronic acid (Reclast), can be given as a yearly infusion.
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- Hip Fractures. Merck Manual of Health and Aging. http://www.merck.com/pubs/mmanual_ha/sec3/ch23/ch23b.html. Accessed Nov. 24, 2009.
- Burroughs KE. Hip fractures in adults. http://www.uptodate.com/home/index.html. Accessed Nov. 24, 2009.
- Hip fractures. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00392. Accessed Nov. 24, 2009.
- Osteoporosis Prevention: Who's at risk. National Osteoporosis Foundation. http://www.nof.org/prevention/risk.htm. Accessed Nov. 24, 2009.
- Kiel DP. Falls in older persons: Risk factors and patient evaluation. http://www.uptodate.com/home/index.html. Accessed Nov. 24, 2009.
- Kiel DP. Prevention of falls and complications of falls in older persons. http://www.uptodate.com/home/index.html. Accessed Nov. 24, 2009.
- Live it safe: Prevent broken hips. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00305. Accessed Nov. 24, 2009.
- LaVelle DG. Fractures and dislocations of the hip. In: Canale ST, et al. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/172615262-3/0/1584/390.html?tocnode=55689267&fromURL=390.html#4-u1.0-B978-0-323-03329-9..50055-6--cesec1_2948. Accessed Nov. 24, 2009.
- Morris VA, et al. Medical management of the patient with hip fracture. In: Browner BD, et al. Skeletal Trauma. 4th ed. Philadelphia, Pa.: W.B. Saunders; 2008. http://www.mdconsult.com/das/book/body/172615262-4/919970406/1867/52.html#4-u1.0-B978-1-4160-2220-6..10047-7--s0240_2185. Accessed Nov. 24, 2009.
- Auron-Gomez M, et al. Medical management of hip fracture. Clinics in geriatric. 2008;24:701.
- Osteoporosis overview. National Institute of Arthritis and Musculoskeletal Diseases. http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/default.asp. Accessed Nov. 24, 2009.
- Nutrition and bone health. National Institute of Arthritis and Musculoskeletal Diseases. http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/Nutrition/default.asp. Accessed Nov. 24, 2009.
- Baumgaertner MR, et al. Intertrochanteric hip fractures. In: Browner BD, et al. Skeletal Trauma. 4h ed. Philadelphia, Pa.: W.B. Saunders; 2008. http://www.mdconsult.com/das/book/body/175438862-12/929829121/1867/54.html#4-u1.0-B978-1-4160-2220-6..10049-0--s0300_237. Accessed Dec. 15, 2009.
- Takahashi PY (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 2, 2009.
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