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The femur is your long thigh bone and the neck of femur refers to the narrow part at the top, close to where your thigh bone connects with your pelvis, or your hip. The neck is the most common area for the bone to break, as it is where the bone is at its narrowest.

The words break and fracture mean the same thing, so a fractured neck of femur can also be referred to as a broken hip.

Understanding Hip Fractures

The hip is the largest weight-bearing joint in the body. It's also a common place for a fracture to occur after a fall-especially in older people. Hip fractures are even more likely in people with osteoporosis (a disease that leads to weakened bones). 

A Healthy Hip

The hip is a ball-and-socket joint where the femur (thighbone) joins the pelvis. When the hip is healthy, you can walk, turn, and move without pain. The head or "ball" of the femur (thighbone) fits into a socket in the pelvis.The ball and socket are each covered with smooth cartilage. This allows the ball to glide easily in the socket. Blood vessels supply oxygen and nutrients to keep the hip joint healthy.

01 Healthy Hip

A Fractured Hip

The hip can fracture in many places. Most often, the fracture occurs in the upper part of the femur. You can also have more than one type of fracture at a time.

  • A transcervical fracture is abreak across the neck of thefemur. This type of fracture caninterrupt blood flow to the joint.
  • An intertrochanteric fracture is a break down through the top of the femur.
  • A subtrochanteric fracture is a break across the shaft of the femur.
02 Fractured Hip

Why it needs to be repaired…

A broken bone heals by keeping the broken areas close together to allow new bone to grow and knit the broken bone together. The surgeon will determine the best way of bringing the broken bones together and use metal in order to stabilise it in that position.

Once your fracture has been stabilised you are usually able to put all your weight on your leg and start walking again.

Types of Repair

The location of the break will determine which method your surgeon will choose to repair the fracture. 

Cannulated Screws

Cannulated screws are attached inside the femur to hold the fracture securely. 

 

03 Canulated Screws

Dynamic Hip Screws (DHS)

A metal plate on the outside of
the femur and screws attached
to the femur to hold the fracture securely.

 04 Dynamic Hip Screws

Hemiarthroplasty (Partial hip replacement)

The surface of the head of the femur is replaced with an artificial head (or prosthesis). If you have had this type of repair, you will also need to follow the instructions in the hip precautions section later in this booklet. This will  reduce the risk of dislocating your hip.

 05 Hemiarthroplasty

Total Hip Joint Replacement

Both the hip socket (acetabulum which resembles a cup-shaped bone in the pelvis) and the top of the femur are replaced with an artificial joint (or prosthesis). If you have had this type of repair you will also need to  ollow hip precautions, later in this book to reduce the risk of dislocating your hip.

 06 Total Hip Joint Replacement

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Benefits and Risks with having an operation

This section is not meant to frighten you, but help you to understand the reason for surgery and to help you cope better with any complications that may occur. It is important that you understand that there are possible risks linked with any major operation. An operation to repair your fractured neck of femur is no exception.

Benefits

The main benefit of having an operation is that you will be able to get up and start walking again very soon after your surgery. As with all operations there are some risks associated. The team looking after you will do everything they can to minimise these risks

Risks that can occur

A small percentage of patients may develop complications. Factors such as age and other medical conditions may increase the chance for complications and delay or limit your full recovery. By getting up out of bed the day after your operation, you will be helping to reduce many of these risks.

Bleeding

This is an injection of local anaesthetic near the nerves which go to your leg. This will numb part of the leg and make it pain-free for several hours after surgery. You may also not be able to move it properly during this time.

Bleeding

In some cases you may bleed during the operation and you may require a blood transfusion during or after your operation. Whether you decline or accept any blood components or products, your decision will be respected and treated with privacy.

Infection

An infection can occur in the wound or deep tissue around the repair. This could happen while you are in hospital or after you go home. Minor infections are usually treated with antibiotics but major infections can sometimes require further surgery.

Blood clots, deep vein thrombosis (DVT) 

This is the term used when a blood clot develops in the deep veins in the back of your lower leg. When detected the treatment may involve blood thinning injections followed by a course of tablets. There is a small risk of developing a DVT following surgery.

Delirium

Delirium can sometimes occur after an operation. Delirium is a state of altered consciousness which occurs suddenly (usually within hours or days) as a result of a physical illness or sometimes in response to treatment such as surgery. Delirium is a common condition that can occur in patients of all ages, but does so more frequently in the elderly or those with pre-existing memory conditions.

Delirium occurs in up to 30% of patients following repair of a fractured neck of femur and can be upsetting. If you develop delirium the team will help by reassuring you and helping you to remember what has happened and where you are.

What should family/whānau look out for?

Sudden and new development of:

  • confusion - the patient may seem jumbled and not their usual self
  • disorganised thinking or behaviour
  • anxiety, bewilderment and/or suspiciousness
  • disorientation (not being aware of the correct time and place)
  • loss of interest
  • restlessness or agitation
  • altered sleeping patterns - tendency to sleep at times that are unusual for them
  • withdrawn, drowsy, sedated, lethargic behaviour
  • misunderstanding what is seen and heard
  • delusions (false beliefs) or hallucinations (seeing, hearing or believing things which are not real)

What can family/whānau do to help?

Delirium can be a frightening experience and the calm presence of familiar people can make a big difference in relieving distress. Some things family/Whānau can do to help include:

  • visiting regularly; limit visitors to one or two at a time
  • identify themselves and speak to the patient by name
  • speak slowly and clearly about familiar, simple things
  • use a calm tone and a sense of humour; gentle touch can also reassure and calm
  • try to gently orientate the patient about where they are and what the time and date are (but don't argue if they don't agree)
  • minimise background noise such as music, laughter or TV
  • bring in hearing aids and glasses if the patient needs them
  • encourage and assist with meals and fluids; you can bring in a favourite meal
  • inform nursing staff of any special information relating to the person
  • ask staff if there is something you can do to help; sometimes one person staying quietly in the evening may help the person go to sleep

Conservative or non-surgical treatment

Conservative treatment is rarely considered, however it may be necessary if surgery is not possible - for example if someone is too frail to cope with surgery, or if the hip fracture occurred a few weeks earlier and has started to heal.

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Last updated: October 3, 2017