Hip fracture: fixing it with a nail

Types

• Stable: two pieces
• Three pieces
• Several pieces (unstable)

What is broken

The thigh bone (femur) has broken below the neck of the hip, through the bony bumps where the big hip muscles attach. This is one of the most common fractures after a fall, especially when the bones have become thinner with age.

Why an operation

This fracture does not heal well lying in bed: the pieces slip, the leg becomes shorter and turns outwards, and lying still for weeks brings pneumonia, clots and bedsores. The operation holds the bone so that you can stand up and walk again in the first days.

How the operation is done

Through a small cut at the side of the hip, the surgeon first puts the pieces back in place under X-ray. Then a metal rod (nail) is slid down inside the thigh bone, and a blade or screw goes through it into the ball of the hip. Bone and metal now carry your weight together. It usually takes about an hour.

Anaesthesia and the hospital stay

You will be asleep (general anaesthesia) or numb from the waist down (spinal anaesthesia); the anaesthetist will talk with you about which is best. Most people stay in hospital about a week, then go home or to a rehabilitation clinic.

Possible risks

• Needing a blood transfusion — fairly common, about 1 in 4 to 1 in 3
• Short-lived confusion (delirium), mostly in older people — about 1 in 4
• Wound infection — about 1 to 2 in 100
• Serious general illness (heart, lungs) that can be life-threatening, mainly in frail people — not rare after a hip fracture; your doctor will discuss your own risk
• Blood clot in the leg or lung — about 1 in 100, despite the injections that prevent it
• The screw or blade cuts out of the ball, or the bone does not heal: a second operation — about 2 to 5 in 100

After the operation

You may usually put full weight on the leg straight away, with a walking frame or crutches at first. The physiotherapist starts on day one. The stitches or clips come out after about two weeks. The bone takes about three months to heal; the nail normally stays in for life.

Questions people often ask