Proximal Femur (Hip) Fracture Fixation

⚙️What This Procedure Involves

There are three main fixation methods. Dynamic hip screw (DHS): an incision on the outer thigh, a large screw is placed into the femoral head and connected to a plate on the femur. Used for intertrochanteric fractures. Intramedullary nail: a rod inserted into the femoral canal with screws into the femoral head. Used for intertrochanteric and subtrochanteric fractures. Cannulated screws: three parallel screws placed percutaneously into the femoral head. Used for undisplaced or minimally displaced neck of femur fractures in younger patients. Operations take one to two hours.

💡Why It May Be Recommended

Hip fractures require urgent surgical fixation (ideally within 36 hours) to relieve pain, allow mobilisation, and reduce complications. The type of fixation is chosen based on the fracture pattern. Displaced neck of femur fractures in elderly patients are usually treated with hemiarthroplasty or total hip replacement rather than fixation.

⚖️Non-Operative Alternatives

Non-operative treatment is rarely appropriate due to the severe impact on mobility, pain, and mortality. It may be considered only in patients who are too unwell for any anaesthetic.

📋Preparing for Surgery

Emergency pathway with rapid pre-operative assessment. Optimisation of medical conditions. Surgery within 36 hours is the national standard.

✅Expected Benefits

Pain relief, early mobilisation, and reduced mortality. Hip fracture surgery is one of the most time-critical orthopaedic emergencies. Early surgery significantly improves outcomes.

⚠️Common Risks

• Medical complicationsCommon

  Elderly hip fracture patients have high rates of delirium, chest infection, urinary infection, and cardiac events.

• Blood lossCommon

  Significant blood loss. Transfusion may be needed.

• PainExpected

  Post-operative pain requiring regular medication.

🔴Less Common but Serious Risks

• Metalwork failureUncommon

  The screw may cut out of osteoporotic bone. Risk approximately 5-10% for DHS and nails.

• Non-union (neck of femur)Common

  Neck fractures fixed with screws have a non-union rate of 10-30% and AVN rate of 10-20%.

• Avascular necrosisCommon

  Loss of blood supply to the femoral head after neck fractures.

• InfectionUncommon

  Wound or deep infection.

• Blood clotsCommon

  DVT or pulmonary embolism. Very common without prophylaxis.

• MortalityExpected

  One-year mortality after hip fracture in the elderly is approximately 20-30%, primarily from pre-existing medical conditions.

💉Anaesthetic Considerations

General or spinal anaesthesia. Regional nerve blocks for pain management. Spinal anaesthesia may be preferred in high-risk patients.

🏃Recovery and Rehabilitation

Most patients begin mobilising the day after surgery with physiotherapy support. Walking aids (frame or crutches) are used for six to twelve weeks. Many elderly patients require inpatient rehabilitation. Return to pre-fracture function is the goal but is not always achievable, particularly in frail patients. Falls prevention and osteoporosis treatment are essential.

📅Follow-Up

X-ray at six weeks and three months. Bone health assessment and osteoporosis treatment. Falls prevention programme. Regular medical review.

❓Frequently Asked Questions