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Hip Fracture Physiotherapy

A hip fracture is a crack, a break or fracture in the long thigh bone, near the hip joint.

These kinds of hip injuries and fractures are more commonly in elderly and individuals who have compromised bone health such as having osteoporosis, and these bones are fragile and break easily due to fragility. It can be as easy as a small bump against a firm surface, a twist or an actual slip and fall.

That being said, hip fractures can also happen in high-trauma incidences such as

• motorbike/car/vehicular-related accidents
• sports such as wrestling, mix martial arts
  
• bullets
• falling from height or with force
  

There are four locations of hip fractures:

• femoral head fracture
• femoral neck fracture
• subcapital fracture or intra-capsular fracture
• subtrochanteric fractures that involve the shaft of femur as well

Unfortunately...there is high mortality risk and rates usually associated with hip fractures (up to 35%). This is because of the causes and sub-risks related to hip fractures, which are:

• elderly, who because of these hip fractures, be it managed with surgery or not, may become more home and worse is bed-bound, which may compromise their lung function, which can lead to lung infections (hence will require a lot of chest physiotherapy as well as fracture rehab physiotherapy, which helps them get up and about)
• high velocity/impact accidents with risk of multiple injuries

That being said, our senior physiotherapists have treated and managed hundreds if not thousands of hip fracture cases, so we are more than confident to help provide hip fracture physio for you or your loved ones.

Signs and symptoms of hip fractures

As mentioned earlier, there are two general groups of individuals who suffer from hip fractures:

1. elder, who had a fall or bump that caused the fracture
2. younger population who got the hip fracture from a high-impact accident/sports
   

Patients always present with pain and most of the time, will not be able to weight bear on the affected leg or hip because of the pain. In some cases, the referring doctor will advise if the patient can full weight bear or partial weight bear or no weight bear, but even then the pain experienced may limit their hip movement.

hip fracture Risk factors

For patients who fractured their hips, generally they sustained a pathological fracture, of which the most common causes are:

1. Osteoporosis-weakened fragile bones
   
2. Presence of metabolic bone diseases e.g. Paget's disease, osteomalacia, osteopetrosis and osteogenesis imperfecta
   
3. Bone cancers or tumors
4. Previous bone fractures that hadn't healed or didn't heal properly
   
5. Cancer that had spread/traveled from another site (metastatis)
   
6. Bone infections

Diagnosing hip fractures

Diagnosing hip fractures is fairly direct and straight forward. Patient who had a fall or accident and reports painful hips (sometimes they may not report pain due to the adrenaline), and the attending doctor will request X-ray immediately and 2 weeks time to confirm hip fracture or not.

Why patients may need another x-ray in 2 weeks time is generally moreso when patient's immediate x-ray doesn't present any fractures due to swelling or very small fractures, but can be easier seen in 2 weeks time.

hip fracture Management

For hip fractures that are obviously clear fractures, patients should consider corrective surgery, unless it's just a very minor crack with no displacement (ie known as "stable undisplaced fractures/cracks") or patient has other conditions that doesn't allow surgery.

If the fracture is clear, displaced (or worse, fragmented and/or rotated), patient will always benefit from immediate corrective surgery rather than just rest in bed, because being bed-bound/immobile has a few bad risks including compromised lung functions and risk of lung/chest infections.

Of course, there will be presence of pain with or without surgery, but the difference is with corrective surgery is that patient can have the chance to be mobile by day 1 post surgery, to move around, and have hope. And we as senior orthopedic physiotherapists will do our utmost to get them to sit to stand, stand, do activities and exercises in standing, to walking a few steps, to walking around, to walking further and more.

That's why patients with hip fractures especially, be it having conservative (non-surgery) or choosing for surgery, will always 100% benefit from orthopedic physiotherapy with us. That's why orthopedic surgeons will always refer for physiotherapy to train patient's mobility, chest function and more.

For simple hip fractures, the operating orthopedic surgeon will tend to use screws and plates to preserve the bone, but for older patients with serious hip fractures, they may recommend a full hip replacement instead, which allows for immediate mobilization and even to walk around (which helps a lot in chest function, recovery rate, motivation etc).

If your surgeon by accident forgot to refer you to physiotherapy, gently nudge and remind them (they're often very busy and overworked, so sometimes will forget - check the doctors we serve), or you can contact us directly too, and we'd be more than happy to serve.

In some situations, the doctors or family may determine that the risks associated with surgery may be too high, then the management focus will automatically change to non-surgical hip fracture management, which entails:

• no operational procedures
• protect the hip fracture and prevent worsening (eg further displacement etc)
• prevent secondary infections such as lung/chest infections (requires chest physiotherapy)
  
• prevent secondary issues such as pressure sores (skin breakdown) etc due to prolonged immobilization (requires mobilization physiotherapy)
  

In some cases, the doctor may call for patient to be bed-bound and apply traction to position the hip fracture properly, coupled with daily (sometimes up to three times daily) chest physiotherapy and bed-side physiotherapy. This is to prevent chest infection, pneumonia, joint stiffness, pressure sores, deep vein thrombosis (DVT) etc

hip fracture potential Complications

The are potential medical complications related to hip fractures. Common ones are:

• non-union where the fractured parts healed independently without uniting
• mal-union where the fractured ends connected in a mal-aligned position
• secondary infections like sepsis and chest/lung infections eg pneumonia
• avascular necrosis (AVN) where blood flow to the fractured site is disrupted and the site starts to decay

Prognosis of hip fracture recovery

Fractures of any kinds are painful and stressful events to elderly patients. In fact, hip fractures and spine fractures are one of the most painful, stressful and potentially life threatening if poorly managed (as mentioned above).

Hip fractures will require active ongoing physiotherapy (chest, mobilization, ambulatory) for full recovery.

Post operative physiotherapy

Where suitable, patients with hip fracture and hip fracture/replacement surgery tend to respond well to

• chest physiotherapy
• mobilization physiotherapy
• ambulatory physiotherapy
• strengthening, balance and stamina physiotherapy
• community physiotherapy
  

and aim for the patient to achieve 100% recovery post surgery and post surgery physiotherapy.