Hip Fractures in Older Adults: Closed PFN Surgery
Hip fractures in older people need prompt treatment. Closed fixation with a PFN aims to get the patient back on their feet quickly.
In older people, hip fractures usually happen after a simple fall at home. Osteoporosis is the main underlying cause. A hip fracture in an older person is not just a bone problem but a serious condition that threatens health and independence. Long periods in bed lead to pneumonia, blood clots, pressure sores and muscle loss. The aim of treatment is therefore to get the patient up as soon as possible.
Types of hip fracture
- Femoral neck fractures: Fractures just below the head of the thigh bone. They are often treated with a replacement (partial or total).
- Intertrochanteric and subtrochanteric fractures: Fractures below the neck. Fixation with a PFN is the most commonly used method.
Signs
Severe pain in the groin or hip after a fall, inability to stand or bear weight, and a leg that looks shorter and turned outwards are typical. Some patients only describe vague hip pain; in older people, hip pain after a fall should always be assessed.
What is a PFN (proximal femoral nail)?
A PFN is an implant placed inside the canal of the thigh bone, with a screw or blade extending into the femoral head to hold the fracture. The operation is done with a closed technique: the fracture is aligned from the outside on a special table under X-ray control, and the nail is inserted through small incisions at the side of the hip. Because the fracture site is not opened, blood loss and tissue damage are lower.
Why is early surgery important?
For patients who are fit enough, surgery is recommended as soon as possible, ideally within the first 24-48 hours. Early surgery reduces pain, allows early movement and lowers the risk of complications from being bedbound. Heart, lung and kidney function are assessed and medications adjusted before surgery.
Recovery
- Patients whose condition allows are helped to stand with a walker the day after surgery.
- Walking and strengthening are practised with a physiotherapist.
- After discharge, the home is arranged to prevent falls.
- Osteoporosis treatment is started or adjusted.
Preventing falls and new fractures
After a hip fracture, the risk of another fracture rises. Osteoporosis treatment, vitamin D and calcium, home adjustments (rugs, lighting, grab rails), eye checks, balance exercises and reviewing medicines that cause dizziness are all important.
How families can help
Helping the patient get up early, drink and eat enough and live in a safe home environment plays a big part in recovery.
Frequently asked questions
Isn't surgery risky for an older patient?
Every operation carries risk. But not operating on a hip fracture leads to long periods in bed and the serious problems that come with it. The decision is made with the family after assessing the patient's overall health.
Will they walk again after surgery?
Getting the patient walking again is the main goal of treatment. Walking ability before the fracture and general health affect the result.
Does the PFN have to be removed?
No. In older patients the nail is usually left in place permanently.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.