Joel C Williams MD

Joel Williams, M.D. brings seven years of training and passion for complex fracture care, post-traumatic deformity, pelvis & acetabular surgery and complex hip surgery to Rush University Medical Center.

Fracture Surgery

Hip Fracture

A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis.

The word “Fracture” implies to broken bone. A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries are common cause of stress fractures in athletes.

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture.

Medical Treatment

The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and to remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.

Non-operative (closed) treatment comprises of casting and traction (skin and skeletal traction).

  • Splinting, casting, and/or bracing
    closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.
  • Traction
    Traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction.

Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the pelvis, hip and femur.

Surgical Treatment

  • Open Reduction and Internal Fixation (ORIF)
    This is a surgical procedure in which the fracture is re-aligned and stabilized with internal fixation. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails. This can be accomplished with open surgical techniques (open incision) or percutaneous (minimally invasive) techniques.
  • External fixation
    External fixation is a procedure in which the fracture stabilization is done at a distance from the site of fracture. It helps to maintain bone length and alignment.

Rehabilitation

Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of cast or brace so that the bone become solid enough to bear the stress. Rehabilitation program involves exercises and gradual increase in activity levels until the process of healing is complete.

Hip

Falls and Hip Fracture

The thigh bone, femur, and the pelvis, acetabulum, join to form the hip joint. The hip joint is a “ball and socket” joint. The “ball” is the head of the femur, or thigh bone, and the “socket” is the cup shaped acetabulum.

The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.

The cartilage cushions the joint and allows the bones to move on each other with smooth movements. This cartilage does not show up on X-ray, therefore you can see a "joint space" between the femoral head and acetabular socket.

Hip Fractures

The hip joint is a “ball and socket” joint. The “ball” is the head of the femur or thigh bone and the “socket” is the cup shaped acetabulum. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.

Hip fracture is a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part – the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter. Hip fracture is most frequently caused after minor trauma in elderly patients with weak bones, and by a high-energy trauma or serious injuries in young people. Long term use of certain medicines, such as bisphosphonates to treat osteoporosis (a disease causing weak bones) and other bone diseases, increases the risk of hip fractures.

Signs and symptoms of hip fracture include

  • Pain in the groin or outer upper thigh
  • Swelling and tenderness
  • Discomfort while rotating the hip
  • Shortening of the injured leg
  • Outward or inward turning of the foot and knee of the injured leg

Your doctor may order an X-ray to diagnose your hip fracture. Other imaging tests, such as magnetic resonance imaging or (MRI), may also be performed to detect the fracture.

Depending on the area of the upper femur involved, hip fractures are classified as

  • Intracapsular Fracture
  • Intertrochanteric Fracture
  • Subtrochanteric Fracture

Hip fractures can be corrected and aligned with non-operative and operative methods:

Traction may be an option to treat your condition if you are not fit for surgery. Skeletal traction may be applied under local anesthesia, where screws, pins and wires inserted into the femur and a pulley system is set up at the end of the bed to bear heavy weights. These heavy weights help in correcting the misaligned bones until the injury heals.

Hip fractures can be surgically treated with external fixation, intramedullary fixation, or by using plates and screws.

Subtrochanteric Hip Fracture

A hip fracture is a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.

Subtrochanteric hip fracture is a break between the lesser trochanter and the area approximately 5 centimeters below the lesser trochanter. The fracture can be classified based on its location:

Type I occurs at the level of the lesser trochanter,

Type II occurs within 2.5 cm below the lesser trochanter and, Type III occurs between 2.5 and 5 cm below the lesser trochanter.

Causes

A subtrochanteric hip fracture is most frequently caused from minor trauma in elderly patients with weak bones, and by high-energy trauma in young people. Long term use of certain medicines, such as bisphosphonates to treat osteoporosis (a disease causing weak bones) and other bone diseases, increases the risk of subtrochanteric hip fractures.

Signs and Symptoms

Signs and symptoms of subtrochanteric hip fracture include

  • Pain in the groin or outer upper thigh
  • Swelling and tenderness
  • Discomfort while rotating the hip
  • Shortening of the injured leg
  • Outward or inward turning of the foot and knee of the injured leg

Diagnosis

Your doctor may order an X-ray to diagnose subtrochanteric hip fracture. Other imaging tests, such as magnetic resonance imaging (MRI) may also be performed to detect the fracture.

Treatment

A subtrochanteric fracture can be corrected and aligned with non-operative and operative methods. Traction may be an option to treat your condition if you are not fit for surgery. Skeletal traction may be applied under local anesthesia, where screws, pins and wires are inserted into the femur, and a pulley system is set up at the end of the bed to bear heavy weights. The heavy weights help in correcting the misaligned bones until the injury heals.

Surgery

Surgery is usually the main treatment for subtrochanteric fractures. Surgical options include external fixation, intramedullary fixation or by using plates and screws.

External fixation is a temporary fixation and used for severe open fractures. Pins are inserted into each of the fractured fragment and supported with tubes close to the bone. The tubes are interconnected together with short tubes to provide more stiffness for the frame.

Intramedullary fixation involves managing the fracture with a long intramedullary nail which is fixed with a large screw. Additional screws known as interlocking screws are inserted at the lower end of the nail to prevent rotation of bones around the nail.

You surgeon may use a plate with screws attached instead of a nail in certain cases. Screws will be fixed into the bone from the outer side of the femur. A large screw will be inserted through the femoral neck and head, and other screws will be inserted across the length of the plate to hold the fracture together.

Risks and Complications

As with any surgical procedure, surgery for a sub trochanteric fracture involves certain risks and complications including:

  • Nonunion of fracture with pain
  • Limp or limited hip rotation due to malunion
  • Nail or screw fixation failure
  • Wound infection

Pelvis Fractures

Pelvic fracture

Pelvic fracture is a condition that arises due to breakage of the pelvis bones. It may damage internal organs, nerves, and blood vessels associated with the pelvis region.

The pelvis is a round structure of bones located at the base of the spine, connected to the sacrum of the spine with the help of strong ligaments. The pelvis is composed of three bones, namely ilium, ischium, and pubis that are fused together. The side of the pelvis is composed of a cup shape socket, known as acetabulum.

Various organs related to the digestive and reproductive systems lie within the pelvis ring. Also, several large nerves and blood vessels supplying the lower limbs pass through the pelvis. The pelvis ring also acts as point of attachment for muscles approaching from the upper and lower part of the body.

Based on the damage of the pelvis ring and associated structures, pelvic fractures can be categorized as:

  • Stable pelvic fractures: bones remain in position and do not require surgery
  • Unstable pelvic fractures: requires immediate medical care and often require surgery.

Causes

The common causes responsible for pelvic fractures include:

  • Motor vehicle or motorcycle collision
  • Accidental injury or fall from a great height
  • Sports injuries or trauma
  • Conditions such as osteoporosis, especially in elderly people

Symptoms

The common symptoms associated with pelvic fractures are:

  • Pain and swelling in the groin or hip region that may worsen with ambulation
  • Abdominal pain
  • Bleeding through the urethra or vagina and the rectum
  • Problems in urination
  • Unable to stand or walk

Diagnosis

The diagnosis of pelvic fracture starts with physical examination including checking the functional activity of the various body organs present in the pelvic region. Imaging techniques such as X-rays, CT (Contrast Tomography) and MRI (Magnetic Resonance Imaging) scan may also be used to confirm the exact condition or breakage of the pelvic bones. In some cases, additional contrasting studies using radioactive dye may be recommended to evaluate the structural and functional activity of organs such as the urethra, bladder, and the pelvic blood vessels.

Treatment

Treatment of the pelvic fracture depends upon the severity of the injury and condition of the patient. Minor or stable fractures can be treated with conservative methods such as rest, medications, use of crutches, physical therapy, and if required minor surgery. These methods may take 8–12 months for complete healing.

The treatment of unstable fractures includes management of the bleeding and injuries of the internal organs, blood vessels, and nerves. Surgical intervention may be employed for fixation of the fractured pelvic bones using screws and plates. Pelvic bone fixation provides stability to the pelvic bone and promotes natural healing of the fracture.

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