 Hip Fracture
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The hip bone, which is contained in the lower part of the trunk of the body or the pelvis, is comprised of three separate bones: the illium (upper part), ischium (lower part) and the pubis (the central bone that unites with the ischium at either side. Fractures (a partial or complete break in the bone) can occur in any of these areas, near the top of the thighbone (femur) where it angles into the hip socket, or in the cup-shaped depression of the hipbone, called the acetabulum, which is the socket in which the thighbone rotates.
Hip fractures, although quite common in elderly men and women, are rare among children because the immature hipbone is more supple and stronger than that of an adult. This flexibility allows a child's hipbone to absorb greater energy than an adult hipbone before a fracture occurs.
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Fractures occur when there is more force applied to the bone than the bone can absorb. Bones are weakest when they are twisted. Breaks in any bone can occur from falls, trauma or as a result of a direct blow to the body.
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While hip fractures among older people are commonly caused by falls, the most common cause of hip fractures in children is motor vehicle accidents. Hip fractures in teen-agers are commonly due to athletic injuries.
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Hip fractures in children are not common, occuring in 1 out of 100,000 children each year.
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The following are the most common symptoms of a hip fracture. Each child may experience symptoms differently. Symptoms may include:
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- intense pain in the injured area
- swelling in the injured area
- obvious deformity in the injured area
- difficulty using or moving the injured area in a normal manner
- warmth, bruising or redness in the injured area
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The symptoms of a hip fracture may resemble other conditions, but if you suspect the hip has been fractured, seek emergency assistance and place a thick padding of blanket, towels or sheets between the child's legs without moving them.
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The physician makes the diagnosis with physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the child and asks how the injury occurred. The physician also will look for any injuries commonly associated with hip fractures. These can include injury to any of the structures housed by the pelvic bones, including the lower portion of the intestines and rectum, the urinary bladder and the internal organs of reproduction. Other commonly associated injuries include head injuries and additional fractures.
The doctor will examine any lacerations to determine whether an open fracture (bone visible through the skin) has occurred, and will press on front and back of the pelvic area to help determine how stable the hip is. A rectal examination also may be performed to look for hemorrhage that may signify bone penetration into the rectum.
Other diagnostic procedures may include:
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The doctor will examine any lacerations to determine whether an open fracture (bone visible through the skin) has occurred and will press on front and back of the pelvic area to help determine how stable the hip is. A rectal examination may also be performed to look for hemorrhage that may signify bone penetration into the rectum.
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Other diagnostic procedures may include:
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- X-rays — A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. this test is used to measure and evaluate the curve.
- Magnetic Resonance Imaging (MRI) — A diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
- Computerized Tomography Scan (also called a CT or CAT scan) &madash;A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images (often called "slices"), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.
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Specific treatment for a fracture will be determined by your child's physician based on:
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- your child's age, overall health and medical history
- extent and location of the fracture
- your child's tolerance for specific medications, procedures or therapies
- expectations for the course of the fracture
- your opinion or preference
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The goal of treatment is to control the pain, promote healing, prevent complications and restore normal use of the fractured area. Most pelvic fractures in children have a favorable result with a minimum of treatment followed by an aggressive rehabilitation program.
Fractures that are stable, in which the bone is not at all displaced from its normal position, may be managed solely by a period of casting. If the fracture involves a minimal displacement of the bone, the treatment may involve a more prolonged period of immobilization with surgically placed pins.
More severe displacement of bone, and acetabular fractures, which require precise restoration of joint congruity, may involve more aggressive surgical treatment. These treatments can include:
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- Surgery — Required to put certain types of broken bones back into place. Occasionally, internal fixation (metal rods or pins located inside the bone) or external fixation devices (metal rods or pins located outside of the body) are used to hold the bone fragments in place to allow alignment and healing.
- Reduction — Reduction involves realignment of the fractured bone. This can be done through an incision made into the fracture site (open reduction) or by external manipulation without an incision (closed reduction).
- Traction — The application of a force to stretch certain parts of the body in a specific direction. Traction consists or pulleys, strings, weights and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the broken bone to allow the bone ends to align and heal.
- Medication (for pain control).
- Pelvic sling or cast — Immobilizes the injured area to promote bone alignment and healing to protect the injured area from motion or use. For information on different types of casts, see Cast Types and Maintenance.
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