Hip Fractures?
Discussion
On the evening of 10th August I was out for a training ride here in the Middle East. During the ride it started to rain and on the way back (at walking speed) I lost the bike and landed on my side resulting in the fracture.
Due to my remote location I did not get to hospital until the next day and then had surgery to insert the screws on 12th August, with discharge from hospital on 19th August.
My one and two month x-rays continue to show the fracture "collapsing" and the screws "backing out". At the last consultation with the surgeon he said "it might heal" and he reminded me that there was a chance that the neck of the femur may still die due to the length of time between the fracture and surgery.
The surgeon also talked about replacing the screws for shorter ones which would offer more support and not stick out so much.... Would this be as involved as the original surgery or more of a quick in and out?
Another concern is that it does not seem to be healing which is becoming very aggravating to me. Has anyone experienced this type of injury? How long did you take to heal?
I have a CT scan on the 12 week anniversary where I will discuss the options with the surgeon. All will probably be fine, but for now I just wondered what your experiences have been?
Due to my remote location I did not get to hospital until the next day and then had surgery to insert the screws on 12th August, with discharge from hospital on 19th August.
My one and two month x-rays continue to show the fracture "collapsing" and the screws "backing out". At the last consultation with the surgeon he said "it might heal" and he reminded me that there was a chance that the neck of the femur may still die due to the length of time between the fracture and surgery.
The surgeon also talked about replacing the screws for shorter ones which would offer more support and not stick out so much.... Would this be as involved as the original surgery or more of a quick in and out?
Another concern is that it does not seem to be healing which is becoming very aggravating to me. Has anyone experienced this type of injury? How long did you take to heal?
I have a CT scan on the 12 week anniversary where I will discuss the options with the surgeon. All will probably be fine, but for now I just wondered what your experiences have been?
I'm a hip surgeon. You have had a bad injury with a significant risk that the fracture won't heal or the head of the femur will lose its blood supply and collapse. The options for successful treatment in these circumstances are limited and you might end up with a hip replacement. Email me if you'd like some advice.
Spooky, back in January of this year I came off my bike one Sunday on some ice, a very innocuous fall to the side at about 15mph.
However my leg was instantly numb and all I could do was drag myself to the side of the road.
Luckily I was out with a club so there were plenty of guys around to help me out of the road and make the call to ambulance.
Later that evening I was on the table with a confirmed fracture to the neck of the right femur and about to undergo surgery to insert 3 cannulated screws.
I was discharged on the Wednesday hobbling around on my crutches.
Two weeks later I had my first physio appointment for a range of movement check, so far so good.
At the 6 week point I was back in hospital for my routine x-ray to check things were healing, thankfully it was and I was given the all clear to start weight bearing on it.
I had another x-ray at 12 weeks and again things were looking good, my physio was going well and strength was returning.
After my 1-2-1 physio I was enrolled into a physio circuit class, around 6 people with 1 physio on a Friday afternoon for 6 weeks. By this time I was doing pretty well but it gave me a good reason to makesure I kept up with my exercises and discuss any concerns with the physio.
I was back in for a 6 month x-ray in mid July, the fracture was healing nicely and still no sign of necrosis. At previous x-rays the post appointment had been with a different consultant, but this one was with the original surgeon, Dr James Murray (https://www.nbt.nhs.uk/our-services/a-z-consultants/mr-james-murray) and I was touched that he remembered me and even asked how my young son was.
At the time of the accident we had a 2 week old baby boy, my paternity leave was just ending and I was settling myself back into a routine, oops!
The first few weeks were dark, really dark and very depressing.
Here we were with a few week old baby, a wife recovering from the birth and now a husband laid up with a broken hip!
Painwise I was pretty good after 4 or 5 days, the only thing I took past this was the anti blood clotting injections and the odd paracetemol. The tramadol made me feel terrible so I ditched it asap.
I was, am lucky that my fracture is healing well and I have had little discomfort or issues since but there are still risks and that will always rest of my mind.
I was back at work, from home in mid April, then back in the office at the start of May, I was also back on the bike around mid June having spent a few weeks on a spin bike before hand.
I'm so sorry to hear that you are having some major issues, are there talks of full or partial replacement? That was one of the options explained to me should the cannulated screw surgery not work out.
The one positive from this was spending 3 lovely months at home with my son, I really do think he picked up on the situation and the stress that my wife and I were going through as he was such a good little boy making things so much easier.
I know we're in different positions but feel free to ask me anything.
However my leg was instantly numb and all I could do was drag myself to the side of the road.
Luckily I was out with a club so there were plenty of guys around to help me out of the road and make the call to ambulance.
Later that evening I was on the table with a confirmed fracture to the neck of the right femur and about to undergo surgery to insert 3 cannulated screws.
I was discharged on the Wednesday hobbling around on my crutches.
Two weeks later I had my first physio appointment for a range of movement check, so far so good.
At the 6 week point I was back in hospital for my routine x-ray to check things were healing, thankfully it was and I was given the all clear to start weight bearing on it.
I had another x-ray at 12 weeks and again things were looking good, my physio was going well and strength was returning.
After my 1-2-1 physio I was enrolled into a physio circuit class, around 6 people with 1 physio on a Friday afternoon for 6 weeks. By this time I was doing pretty well but it gave me a good reason to makesure I kept up with my exercises and discuss any concerns with the physio.
I was back in for a 6 month x-ray in mid July, the fracture was healing nicely and still no sign of necrosis. At previous x-rays the post appointment had been with a different consultant, but this one was with the original surgeon, Dr James Murray (https://www.nbt.nhs.uk/our-services/a-z-consultants/mr-james-murray) and I was touched that he remembered me and even asked how my young son was.
At the time of the accident we had a 2 week old baby boy, my paternity leave was just ending and I was settling myself back into a routine, oops!
The first few weeks were dark, really dark and very depressing.
Here we were with a few week old baby, a wife recovering from the birth and now a husband laid up with a broken hip!
Painwise I was pretty good after 4 or 5 days, the only thing I took past this was the anti blood clotting injections and the odd paracetemol. The tramadol made me feel terrible so I ditched it asap.
I was, am lucky that my fracture is healing well and I have had little discomfort or issues since but there are still risks and that will always rest of my mind.
I was back at work, from home in mid April, then back in the office at the start of May, I was also back on the bike around mid June having spent a few weeks on a spin bike before hand.
I'm so sorry to hear that you are having some major issues, are there talks of full or partial replacement? That was one of the options explained to me should the cannulated screw surgery not work out.
The one positive from this was spending 3 lovely months at home with my son, I really do think he picked up on the situation and the stress that my wife and I were going through as he was such a good little boy making things so much easier.
I know we're in different positions but feel free to ask me anything.
arn22110 said:
The surgeon also talked about replacing the screws for shorter ones which would offer more support and not stick out so much.... Would this be as involved as the original surgery or more of a quick in and out?
this seems illadvised.If one method doesn't work, and it may be Ok for you, but backing out screws really implies a problem deeper in, then repeating the same-ish method doesn't convince me.
If your screws were/are titanium then an MRI may show how much healing is going on, minimal MRI artifact or bloom. If they are steel then MRI is little use.
Consent for screws involves risk of failure of screw fixation.
Thanks for the replies.
OCD
email sent
Matt_N
I think I read about your fall some time ago it is good to know that you are healing and back on a bike. I really do miss getting out on the bike and have promised myself a new one when I get mobile again. I am now experiencing the lows you mentioned, not really knowing how this will pan out is the main problem.
I am preparing myself for the replacement but that will depend on what the Doctors say.
It is strange but there really has not been any excessive pain, the worst part was the burning under the skin from what I was told was the nerves etc repairing. Yes it does hurt getting in and out of the car and out of bed but all in all not too bad. So far I have lost 1.5" off the circumference of my thigh, I thought it would be more.
Three weeks after the operation I was diagnosed with a blood clot so am now on warfarin for six months.... They did not give me any of the home injection I am told they give you in the UK.
The_Doc
Yes I think I agree about the screw replacement, I guess it would be like putting a screw in plasterboard?
I have the CT scan on 5 November but the consultant did say he might do an MRI to look at the bone density, but the screws may be an issue for that.
The second consultant I am now seeing has been good, but I will likely go elsewhere if/when I need the replacement.
OCD
email sent
Matt_N
I think I read about your fall some time ago it is good to know that you are healing and back on a bike. I really do miss getting out on the bike and have promised myself a new one when I get mobile again. I am now experiencing the lows you mentioned, not really knowing how this will pan out is the main problem.
I am preparing myself for the replacement but that will depend on what the Doctors say.
It is strange but there really has not been any excessive pain, the worst part was the burning under the skin from what I was told was the nerves etc repairing. Yes it does hurt getting in and out of the car and out of bed but all in all not too bad. So far I have lost 1.5" off the circumference of my thigh, I thought it would be more.
Three weeks after the operation I was diagnosed with a blood clot so am now on warfarin for six months.... They did not give me any of the home injection I am told they give you in the UK.
The_Doc
Yes I think I agree about the screw replacement, I guess it would be like putting a screw in plasterboard?
I have the CT scan on 5 November but the consultant did say he might do an MRI to look at the bone density, but the screws may be an issue for that.
The second consultant I am now seeing has been good, but I will likely go elsewhere if/when I need the replacement.
Hi Andy,
My physio exercises consisted of:
6 minutes walking on a treadmill, starting slow then working up to a brisk walk
Squats with 5kg DBs
Bodyweight squats on a balance board
Single leg dips
Lunges
Clamshells progressing with a resistance band
Hip bridges
Bike wise, I started on the spin bike, first few times were literally just a few minutes at a sedate pace to get everything working again.
I then moved onto following some beginners spin class videos on YouTube, progressing to some harder HIIT ones.
Then once I took back to the bike I just continued doing my exercises a couple of times a week at home.
I'm still having to do them now and can feel it I start to miss them for a few days, you've really got to keep it up.
Best of luck.
My physio exercises consisted of:
6 minutes walking on a treadmill, starting slow then working up to a brisk walk
Squats with 5kg DBs
Bodyweight squats on a balance board
Single leg dips
Lunges
Clamshells progressing with a resistance band
Hip bridges
Bike wise, I started on the spin bike, first few times were literally just a few minutes at a sedate pace to get everything working again.
I then moved onto following some beginners spin class videos on YouTube, progressing to some harder HIIT ones.
Then once I took back to the bike I just continued doing my exercises a couple of times a week at home.
I'm still having to do them now and can feel it I start to miss them for a few days, you've really got to keep it up.
Best of luck.
Have you had your scan yet? The important thing to know is whether the head of the femur is alive or dead.
Certain types of fractures of the neck of femur (called "intracapsular" fractures of the neck of femur) can interrupt the blood supply to the head and often one has perform a total or hemi-arthroplasty (where you only replace the one half of the joint, in this case the head and neck of femur) depending on the age of the patient. If the fracture is such that the broken bits of bone haven't moved much in relation to each other, the blood supply is generally preserved so 3 cannulated screws to hold them together while the bone heals often gives great results, even in the relatively elderly. If, on the other hand, the broken bits have moved in relation to each other, the chances are that the capsule is torn and blood supply is buggered so you need to go down the replacement route. However hip replacements, or indeed any joint replacement, have a limited life span and repeat surgery is challenging (but of course possible and performed routinely but you would want to avoid it if you can). Therefore, in the very young, who still have a chance that the alternative blood supply to the head is still patent, depending on the severity of the injury, the first choice is always to try save the head so that the joint survives. However, it doesn't always work that way, and indeed, even if there was no visible movement of the fracture on the x-rays, the blood supply can still be interrupted. In that scenario, the head gradually crumbles away.
Now, coming to your situation, it sounds like you've had an intracapsular fracture which was fixed with the 3 screws. What's not clear is whether this was an impacted fracture (where there would be a very high chance that the blood supply remains intact) or whether there was displacement between the two sides (higher chance of blood supply being damaged). The screws backing out could be the first sign of the fact that the head of the femur is dying/dead but that's not always the case. Sometimes the fracture gets compressed further for other reasons. In the former scenario, replacing the screws would be fine, in the latter, the joint would need to be replaced in some manner ("resurfacing" is a term you might come across in this situation but that's just a type of replacement).
I hope that your scan shows that the head is alive, and replacing, or simply removing, the screws is all that you need. Either of those is relatively straightforward. Good luck.
Certain types of fractures of the neck of femur (called "intracapsular" fractures of the neck of femur) can interrupt the blood supply to the head and often one has perform a total or hemi-arthroplasty (where you only replace the one half of the joint, in this case the head and neck of femur) depending on the age of the patient. If the fracture is such that the broken bits of bone haven't moved much in relation to each other, the blood supply is generally preserved so 3 cannulated screws to hold them together while the bone heals often gives great results, even in the relatively elderly. If, on the other hand, the broken bits have moved in relation to each other, the chances are that the capsule is torn and blood supply is buggered so you need to go down the replacement route. However hip replacements, or indeed any joint replacement, have a limited life span and repeat surgery is challenging (but of course possible and performed routinely but you would want to avoid it if you can). Therefore, in the very young, who still have a chance that the alternative blood supply to the head is still patent, depending on the severity of the injury, the first choice is always to try save the head so that the joint survives. However, it doesn't always work that way, and indeed, even if there was no visible movement of the fracture on the x-rays, the blood supply can still be interrupted. In that scenario, the head gradually crumbles away.
Now, coming to your situation, it sounds like you've had an intracapsular fracture which was fixed with the 3 screws. What's not clear is whether this was an impacted fracture (where there would be a very high chance that the blood supply remains intact) or whether there was displacement between the two sides (higher chance of blood supply being damaged). The screws backing out could be the first sign of the fact that the head of the femur is dying/dead but that's not always the case. Sometimes the fracture gets compressed further for other reasons. In the former scenario, replacing the screws would be fine, in the latter, the joint would need to be replaced in some manner ("resurfacing" is a term you might come across in this situation but that's just a type of replacement).
I hope that your scan shows that the head is alive, and replacing, or simply removing, the screws is all that you need. Either of those is relatively straightforward. Good luck.
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