When it comes to fractures, many people first associate them with traffic accidents, earthquake collapses, falls from heights, and so on.
It is true that these are the main causes of fractures in young people. But for the elderly, a gentle bend or even a sneeze can cause a fracture. The old saying “the bones of the elderly are more brittle” actually has some truth, because the incidence of osteoporosis in the elderly is higher, and the bones are more brittle, so not a great external force can cause fractures.
And once the elderly fall, hip fractures often occur. Hip fracture used to be called “the last fracture of life”, which means that people are prone to fracture when they are old, and once a fracture occurs, their lives are in danger.
The fracture itself is not terrible, but the various complications can be fatal.
What’s so special about hip fracture?
First of all, we need to clarify where the “hip” is.
In layman’s terms, it is the part of the thigh that connects to the hip, which is often referred to as the crotch. The hip joint is an important structure that connects the trunk and the lower limbs, with the pelvis on one side and the femur on the other.
Therefore, once the hip is fractured, the patient is mostly unable to walk, and being bedridden for a long time is a serious blow to the patient psychologically and physically.
Most people think of “no surgery” or “no surgery if possible” when it comes to fractures in the elderly. The reason for this is as simple as “I am too old to take such a big hit from surgery”.
However, it should be pointed out that surgery is the preferred treatment for hip fractures in the elderly, provided that the indications for surgery are met.
Why is surgery the preferred treatment?
Is it possible to withstand surgery at such an old age?
In fact, the evaluation of whether a person can withstand surgical trauma is not based on age, but on the status of all systems. The physical condition of the same 80-year-old person is different. Some people have various examinations and find that many organs have hidden problems, while others have no problems after blood sampling.
Therefore, age is not the only decisive factor, and it is not uncommon for centenarians to undergo hip surgery.
There are two reasons for preferring surgical treatment.
Conservative treatment does more harm than good.
Modern surgical treatment has manageable risks and many benefits.
1.Conservative treatment
The so-called conservative treatment is generally described as bed rest, traction and fixation, waiting for the fracture to heal on its own. The cost seems to be low, without the need for surgery and bleeding, and it feels as if it is very safe, but in fact there are more disadvantages.
Care is difficult: elderly people are bedridden for a long time, need to do traction through steel pins in their legs, absolutely cannot get out of bed, and have to urinate and defecate in bed. Every time you move your body or turn over and pat your back will cause severe pain at the fracture site. It is a kind of torture for both the patient and the family.
Long time in bed: Generally, hip fracture usually requires bedside traction and braking for 2 to 3 months or even longer, which is often unbearable for patients.
Complications: prolonged bed rest and compression of the hip and lower back can cause poor local blood supply and bed sores; prolonged braking can lead to muscle atrophy; the incidence of pneumonia and urinary tract infections can also be greatly increased, which can be life-threatening in serious cases.
The treatment effect is poor: except for a few mild fractures with special location and active cooperation of patients, most patients’ fractures tend to heal abnormally or even not, which affects the quality of life in the future.
Several studies have even found that the mortality rate of elderly patients with periprosthetic hip fractures after conservative treatment is close to 50%.
2.Surgical treatment
Most patients can get out of bed within a week after surgery, thus avoiding the serious complications that may arise from long-term bed rest.
More importantly, surgery can restore the function of the hip joint, and recovery is fast. They can return to their original life path soon.
Older people are older, they are not well in the first place, and the risk of surgery is high, in case ……
Is surgery no longer a problem?
Such doubts are understandable.
In the past, hip fracture surgery was very traumatic and the surgical technique was relatively backward, so there was not much difference in the effect of doing surgery or not.
In recent years, however, orthopedic surgery has progressed at a rapid pace, and diseases that were thought to be treated conservatively in the past now have excellent surgical options. The mortality rate of surgical patients is also much lower than that of conservative treatment, and the recovery of joint function is much better.
There are risks associated with any surgery, but thorough preoperative preparation can minimize it. The condition of vital organs is examined in detail before surgery, chronic diseases are controlled before surgery, anemia is treated with blood transfusion, and inflammation is treated with anti-infection treatment.
Even so, doctors will still assess the risk of surgery before surgery and will only recommend surgery if the risk is manageable.
Of course, controlled risk is not the same as no risk. It is just that the overall benefit of surgery is greater compared to conservative treatment.
How is surgery done? Is it possible not to replace the joint?
The most common treatment for fracture is “plate”, “nail” or “joint replacement”. This is also known as internal fixation and artificial hip replacement.
1.Hip replacement
Can you not replace it? It’s always better to have your own, right?
Indeed, “your own” is better. But you can’t keep a broken one.
For anatomical reasons, most of the femoral neck fractures in hip fractures have low healing ability and high chances of femoral head necrosis. In some cases, the fracture does not grow even after years of conservative treatment, and in some cases, even after the fracture has healed, necrosis of the femoral head occurs again after a few years. When they enter the hospital again, they are very passive.
Therefore, doctors tend to prefer artificial joint replacement for femoral neck fractures with significant displacement.
Joint replacement is just like the installation of dentures, although the trauma is not the same, but the essence is the same. The broken one is removed and replaced with a false one. If you can accept dentures, why can’t you accept artificial joints?
2.Internal fixation
There are several kinds of fractures around the hip joint, and the physical function of the elderly varies. Fractures of the femur in the hip fracture generally have a better blood supply, and fracture healing is not a problem, so doctors generally use the method of closed reduction internal fixation. In addition, internal fixation can also be considered for femoral neck fractures that are not significantly displaced.
Is it “nailing” or “joint replacement”? It is up to the doctor in charge to make a comprehensive judgment based on the patient’s condition and general condition. At this time, it is important to communicate with the doctor and refer to professional advice to face the difficulties together.
Who is suitable for conservative treatment?
It is human nature to avoid harm, but sometimes reality is harsh. If a patient’s preoperative evaluation determines that he or she cannot tolerate surgical treatment, conservative treatment in bed becomes a “road to nowhere”.
Therefore, conservative treatment is only appropriate for patients who have multiple serious preoperative comorbidities and are extremely weak and cannot tolerate surgery.
Finally, there is one more important point: prevention is the best treatment. No fall, no fracture!