This research paper do include and provide reliable information on various risk factor and symptoms of hip fracture as well as various treatments that can be applied for patients to lead a near normal life.
Hip fracture is a vernacular term that is used to refer a condition when there is a broken part of bone at the area of hip joint. Hip joint is the articulations between the large spherical femoral head and the deep socket provided by the acetabulum of the pelvis.
This fracture problem tends to affect most of the patients with 65 years old and older due to several risk factors including the age, sex, chronic medical conditions and many more. Symptoms of hip fracture were described in this research paper as well to create awareness to the society.
Various treatments for information and explanation that done by the surgeon and rehabilitation which done by the physiotherapist were also stated in this book.
Hip fracture is a vernacular term used for a condition where there is a broken part of bone at the area of hip joint. This articulation is important to us as it function as one of the weight bearing structure. Broken of the bone is termed as fracture. Anyone might have this problem but mostly, patients who suffered from hip fracture are from elderly age. This is proved where according to eMedicine article, 9 out of 10 hip fractures occurs in patients aged 65 years old and older. However, anyone still have the risk of getting this health problem even for a child.
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Hip joint is a ball-and-socket joint, which involves two bony parts that is femur and pelvis. In order to form the joint, there will be a connection between the head of the femur, which comprises the shape of a ball with acetabulum which is the part of pelvis involved where it works as a socket.
Hip fracture classified into two parts that is intracapsular and extracapsular. Intracapsular hip fractures are fracture that occurs at head of femur and the neck of the femur. Femoral head fracture is usually result from high-energy trauma and the dislocation of hip joint. On the other hand, femoral neck fracture describes a condition where the fracture is adjacent to the femoral head in the neck of the femur between the head and the greater trochanter.
Extracapsular hip fracture is the hip fracture that includes the trochanteric of the femur. It was intertrochanteric hip fracture and subtrochanteric hip fracture. Intertrochanteric fracture somehow denotes a fracture which line between greater and lesser greater trochanter on intertrochanteric line. Otherwise, subtrochanteric fracture defines a fracture, which involves the shaft of the femur. In addition, most of hip fractures do occur at the neck of femur where is about 1-2 inches below the ball portion of the hip.
During the research time, it is found that there are so many symptoms of having the hip fracture where some of us may take it as a slight thing that happen and they will just treat it without applying the correct way and technique, which may cause it to be more severe. They might only realise the problem after the condition is up to where they cannot even walk properly.
Beside the symptoms, people also should be aware of the risk factors that may contribute to this health problem, as the impact on their routine life will be unpredictable. If they have the right and adequate information about this health problem, then they should take the precautions in order from getting more serious.
On the other hand, the treatment of this problem is differing according to which type and which part the fracture occurs. There are many treatment that can be apply to the patients that suffered the disease through different aspect whether it was a physical treatment such as physical therapy, psychological treatment and also through surgery.
Although there are many treatment that can be applied to the patients, the recovery process will take a long time for the patients to be fully recovered and then start to lead a normal life again. Therefore, the best way to prevent it from happening is through a proper way that suggested by professionals in healthcare team.
Throughout the research, it is found out that there are several symptoms that is caused by hip fracture. First was severe pain in the hip area, followed by the other one, which is swelling, tenderness and bruises at hip area. Furthermore, the affected leg will suffer a weakness besides there will be an upper thigh pain. Inability to bear weight and loss of range of motion is also to be the one of the symptoms. Then, patient will also suffer from shortened leg length and it will be hard for them to move appropriately.
Hip fractures caused by several factors such as age, sex, chronicá´µ medical conditions, lack of nutrition, physically inactive, excessive consumption of alcohol and fall and accident of a blow in the hip joint. Increasing of age was the most common factors that occur in people who around 65 and about 9 out of 10 is due to the decreasing of bone density and weaken muscles as age substantially increases. It is about 80% for a woman to have hip fractures as a woman moves beyond menopause. Bone density in women will lose faster than a men do as estrogen² levels drop when a woman is menopause. In chronic medical conditions, endocrine disorders, such as overactive thyroid³ and intestinal disorders, which reduce the absorption of vitamin D and calcium, may increase the risk of bone fragility. Besides, taking a long-term drug that typically used for chronic conditions such as high blood pressure and asthma will gradually effect on bone health. At the young age, peoples with lack of nutrition such as calcium and vitamin D in their diet will lower the peak bone mass and increases risk of fracture later in life. Less participation in weight-bearing exercise such as walking may cause lower bone density and have weaker bones. Additionally, people with immobility and prolonged bed rest can lead to bone loss. Strong bones and muscles can achieve through weight-bearing exercise. Excessive consumption of alcohol and smoking will cause abnormal processes of bone building and remodeling which result in bone loss.
Femoral Neck Fracture:
Femoral neck fracture denotes a fracture in the neck between the head and greater trochanter of femur. At time of injury, blood supply to the fractured portion bone is often disrupted which caused a higher risk of not healing, especially badly fractured bone. This will caused the blood flow diminishingly. There are important criteria need to consider for the femoral neck fracture treatment, such as:
The amount of displacement of fracture
The age of patient
For most femoral neck fractures, the treatment will be one of the following:
Generally, hip pinning only done in patients with femoral neck fracture that is well aligned and minimal displaced. When hip pinning is performed, a patient is given a general or spinal anesthesia4. On the side of the thigh, a small incision is made where a fluoroscope5 is inserted and used by surgeon to guide the metal screws or pins into the correct position to stabilize the broken bones. Soft tissues and metal staples are used to close the incision.
Hemiarthroplasty prosthesis referred to the replacement of the femoral head. Unipolar and bipolar are two types of prosthesis that used by surgeons. Replacement of the femoral head with a solid metal ball and acetabulumis remained is known as unipolar type. The bipolar type is where the swivels6 of the femoral head is attached to the stem whereby the acetabulum is removed. The surgeon will usually advise the patient undergo the bipolar prosthesis as it is attempt to reduce the wear at the acetabular cartilage. Patients may have a cemented prosthesis or uncemented prosthesis and usually decision made by the surgeon. In cemented prosthesis, epoxy7 cement is use to attach the metal to the bone. For an uncemented prosthesis, a fine mesh of holes is bore on a surface that allowed the new bone to grow into the mesh and attach the prosthesis to the bone. When hip hemiarthroplasty is performed, a patient is given a general or spinal anesthesia. A small incision is made on the side of the thigh. After the incision was made, the femoral head is removed from the acetabulum and special rasps (coarse files) are used to shape the hollow femur for an exact shape of metal stem of prosthesis. Stem is inserted into the femoral canal once the size and the shape of hollow femur is perfectly done. Lastly, the surgeon closes the incision with several stitches or metal staples.
Femoral Head Fracture:
Femoral head fractures are very rare injuries that usually caused by hip dislocations, when the hip flexed approximately 90 degrees and slightly adducted. It denotes a fracture in the femoral head as the result of high-energy trauma and dislocation of the hip joint, which often contribute to this fracture. Treatment for the femoral head fractures is due to the Pipkin classification of the fractures. Types of Pipkin classification:
Type 1: Fracture below the fovea
Type 2: Fracture above the fovea
Type 3: Fracture of femoral head with fracture of femoral neck
Type 4: Fracture of femoral head with acetabular fracture
Pipkin types 1 and 2, which also classified as head fractures with concentric reduction and no loose of fragments in the joint can be treated non-operatively. Pipkin with types 3 and 4 requires operative fixation as the fracture occur in the acetabulum. Modified Smith-Peterson is one of the surgical approaches by the surgeon for the anterior fractures or a posterolateral approach with trochanteric osteotomy8 and surgical dislocation of the hip. Besides, other treatments can use to treat the patient due to the experience of the surgeon and level of fractures on the head of femoral. These may include the excision of small fragment, open reduction and internal fixation. Hemiarthroplasty treatment is performed when there is neck fracture due to the classification of Pipkin3.
Treatment for intertrochanteric fracture that conducts by the surgeon is internal and external fixation. Plate and screw, intramedullary rod and screws are use to give support to the femur.
Treatment by using plate and screw, the plate will be place on the lateral side of the femur indicated to provide a more stable attachment of the device used (pin, sliding nail, or screw). The screw will going through the plate into one or two cortices of the femur.
Femur with plate and screw
For the intramedullary rod and screw, which differ from the first method, the rod will be inserted in the middle of the femur in order to provide support to it. The compression screw will be inserted through the head of femur, which will intersect with the intramedullary rod.
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Femur with intramedullary rod & screw
The main treatment that can be applied to the patient is surgery which known as external fixation, open reduction with plates and screws, and intramedullary fixation appeared to be the main technique. External fixation is a temporary treatment, which is applied only to external fracture, and it may lead to complications later. Therefore, it is rarely applied. On the other side, intramedullary fixation where its second generation interlocking nails (cephalomedullary nails) do provide a more stable fixation.
cephalomedullary nail used to fixed subtrochanteric fracture
Besides, cephalomeduullary nail is also one of the devices that are use as a common device in treating subtrochanteric fracture. It is Ninety-five degree fixed-angle devices where used for operative fixation and it will provides a rigid fixation as it was a fixed angle construct.
Sliding hip screw is another device used in the treatment for a very proximal fracture. This device tend to reduces bending movement on the fracture and implant.
REHABILITATION PROCESS AFTER HIP FRACTURE SURGERY BY PHYSIOTHERAPIST
Physiotherapist will carry out several therapy treatments in order to help patient in mobilizing the joint so that stiffness and muscle spasm can be avoid. The physiotherapist on for giving the most suitable types of treatment that should be consider for the benefit of the patients will do prognosis. These are the following therapy treatment can be regulated in order to control the pain and symptoms.
Rest and try to avoid any movement and activities that will increase the pain by using assisting devices recommend by physiotherapist such as crutches and follow physiotherapist assistance on how much weight that can be exerted.
Physiotherapist may used hot pack and heating pad where it should be implied to the sore area for 15-20 minutes up to 4 times each day. Heat will makes blood vessel vasodilate9 thus increasing the blood flows that help to remove the chemical that cause pain and bring in healing nutrients and oxygen. However, heat therapy treatment can only be implied to patient after a long period.
Opposite to heat therapy, ice will make blood vessel to vasoconstrict10 thus decrease the blood flow. This will helps to control inflammation. Physiotherapist may use cold packs, ice bags or ice massage. Cold packs and ice bags have to be place on the sore area within 10-15 minutes. Cryo-cuff is also one of the implements of ice therapy treatments.
Physiotherapist will use electrode pads over the sore area with duration about 15 minutes. This can help to ease pain and decrease swelling by replacing pain impulses with electrical impulses.
Besides therapy treatment, physiotherapist in rehabilitation process can also conduct therapeutic exercise. This exercise is conduct in order to help improve motion, joint mobilization, strength, and endurance in the hip.
IMPROVING RANGE OF MOTION (ROM)
Physiotherapist will use hands-on joint and muscle stretching and many other specific exercises. Active movement and stretching of muscle with overall range of motion (ROM) at the hip joint can help to improve the movement.
Buoyancy of the water helps to make the patient for easier exercise and walk in less stress on hip as the buoyancy of the water lends resistance. Ease soreness, circulation improvement and muscle relaxation can be done with warm water.
Physiotherapist helps to restore the muscle balance that cause by swell and pain due to the post surgery of the hip joint.
PROGRESSIVE RESISTIVE EXERCISES(PREs)
Pulley systems, free weights, rubber tubing, manual resistance, and computerized exercise devices are types of progressive resistive exercises that used in rehabilitation. PREs can be applied as graded resistance of muscle endurance and strength.
Functional training was designed by physiotherapist in order to mobilize the joint.
Physiotherapist will get patient to walk on a treadmill in front of a mirror in order to observe their walking pattern and train to walk on uneven surface as well as to climb up and down of stairs safely.
CLOSED KINETIC CHAIN FUNCTIONAL EXERCISES
This exercise required patient leg or foot to fix on a surface while movement and resistance take place in the joints and muscle. This kind of exercise is important as it involving our routine.
Balance exercise will retrain position sense or called as joint sense. By improving joint sense, it helps to strengthens and stabilizes the hip joint.
Knowing different types of fracture is important because each is treated differently. Risk factors of hip fractures indicate awareness to people whom may have higher probability on getting hip fracture. Besides, experience and knowledge is also important for a surgeon as well as a physiotherapist to give a right treatment to patient.
Chronic: (of a disease) having long duration
Estrogen: any of several major female sex hormones produced primarily by the ovarian follicles of female mammals and preparing the uterus for the reception of a fertilized egg
Thyroid: the largest cartilage of the larynx, forming the projection known in humans as the Adam’s apple
Anaesthesia: general or local insensibility, as to pain and other sensation, induced by certain interventions or drugs to permit the performance of surgery or other painful procedures
Fluoroscope: a tube or box fitted with a screen coated with a fluorescent substance, used for viewing objects, esp. deep body structures
Swivels: fastening device that allows the thing fastened to turn around freely upon it, esp. to turn in a full circle
Epoxy: relating to a compound with one oxygen atom and two carbon atom bonded in a triangle
Osteotomy: the dividing of a bone, or the excision of part of it
Vasodilate: dilatation of the blood vessel
Vasoconstrict: constriction of the blood vessel
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