With the winter months slowly coming to an end, hospitals up and down the country are full of patients who have broken their hip. But why do some patients require emergency surgery whereas others are able to wait for an operation?
The hip joint is made up of the acetabulum and the head of the femur, creating a ball and socket joint. The head of the femur has a unique blood supply. The head is supplied by the retinacular arteries that flow distally to proximally up the neck of the femur. Therefore an intracapsular fracture (a fracture in the neck of the femur) is most likely to have damaged the retinacular arteries and therefore compromised the blood supply to the femur head. This disruption of blood supply means that time is of the essence before the head becomes necrotic (dies). Patients with such a fracture need to be taken into surgery immediately to prevent further complications from a necrotic head of femur.
The less time pressured fracture is called an extracapsular hip fracture, this is more distal than an intracapsular fracture. Therefore is less likely to damage the retinacular arteries and compromise the blood supply to the joint.
There are various surgical options for treatment of these fractures from a dynamic hip screw to a hemiarthroplasty (partial hip replacement) or a total hip replacement. The type of surgery will depend entirely on the patient and their level of function prior to the accident.
Look out for next week’s post when we look at why some people fracture bones easier than others.