Elderly should beware of hip fractures

By Marc Herwig Dec 26, 2011, 3:06 GMT

Berlin - Had Margarete been young, a stumble would have been no big deal. But one day the 76-year-old tripped over the doormat in her hallway and fell.

The diagnosis: a fracture of the neck of the femur, the long bone that extends from the pelvis to the knee.

'I wouldn't have got more than a bruise before. But when I fell this time, the pain was so bad that I really couldn't move,' she recalls.

For people older than 60, a seemingly harmless fall can lead to a hospital stay. A hip fracture was often tantamount to a death sentence a few decades ago, but today most patients are back on their feet after just a few hours.

A femoral neck fracture is almost always a result of osteoporosis, a disease characterized by the gradual thinning of bone tissue and loss of bone density, says Nikolaus Wuelker, medical director of the Department of Orthopaedic Surgery at Germany's Tuebingen University Hospital.

'Until it happens, most patients aren't even aware that they have osteoporosis. There are rarely alarm signals such as pain when weight is put on the limb,' he says. 'But when osteoporosis sufferers fall, they immediately fracture a hip.'

The symptoms of a hip fracture are often unmistakable.

'You're in a great deal of pain, can't put weight on your leg and therefore can't stand up,' says Nils Graf Stenbock-Fermor, chairman of the German Association of Orthopaedic Surgeons. The leg on the side of the injured hip is turned outward and clearly shorter than the other leg.

A femoral neck fracture is almost always repaired surgically nowadays. In the case of a medial femoral neck fracture, the most common form by far, doctors implant an artificial hip.

'Surgery of this kind takes no longer than 30 to 40 minutes, so even quite elderly patients hardly have any problems,' Stenbock-Fermor remarks.

'It's extremely important that patients get back on their feet as soon as possible. They should be able to walk up and down the hospital corridor the very afternoon following surgery.'

Gone are the days when patients had to lie in traction for up to three months, during which many developed pneumonia or a thrombosis. The mortality rate was over 50 per cent several decades ago.

'Today the mortality rate is 3 to 5 per cent. The treatment of femoral neck fractures is one of the greatest success stories in orthopaedics,' Wuelker says. Most patients can leave the hospital after 10 to 14 days and put their full weight on the leg again.

'Patients definitely need intensive physiotherapy afterwards,' Wuelker says. 'The musculature has to start working correctly again. This is why patients limp a little at first.' While physiotherapy is possible on an out-patient basis, many people opt for in-patient rehabilitation.

Although hip fractures are highly treatable and patients like Margarete are usually back on their feet again in no time, Stenbock-Fermor warns against taking chances and suggested some preventative measures. A healthy lifestyle and balanced diet along with exercise such as Nordic walking or cycling help to strengthen bones, he said.