Dr. Patricia C. McKeever, MD

Debridement can be performed either surgically or nonsurgically; some methods are less invasive than others. Doctors select the appropriate debridement technique by considering the location, cause, and size of a patient's wound and may also weigh the patient's overall wellbeing, age, and risk of infection.

Surgical debridement is performed by cutting away dead, infected, and hyperkeratotic skin with a surgical scalpel. For deep wounds that tear away the skin and go into the muscle, skin from another region of a patient's body may be grafted onto the wound, which may then be periodically assessed and rebandaged until fully healed.

Non-surgical debridement is achieved with water or a dissolvent gel. Water softens the damaged skin and affected tissue, allowing doctors to remove it with wet-to-dry dressing. When wet tissue dries, it adheres to the dry dressing or bandage and comes off when the dressing is pulled away. In contrast, dissolvent gel deconstructs tissue, which can be cleaned off of the wound. Nonsurgical debridement is less invasive than surgical techniques; however, it can entail repeat treatments, slowing wound recovery.

While the prospect of stripping away skin may seem jarring, debridement can be critical to the treatment and healing of wounds which cannot not heal independently.

Hip fractures typically occur on the ball of the hip joint, called the femoral head. Types of hip ball fractures include:

• Femoral neck fractures, which occur on the upper end of the femur (thigh bone). The femoral neck is located just beneath the hip ball.
• Trochanteric hip fractures, which occur on a bony bump beneath the femoral neck.
• Although hip socket (acetabulum) fractures are possible, they are less common.

Hip fractures are painful and may make it difficult to stand or walk. If left untreated, patients may be confined to bed rest, which can itself lead to further complications, including muscle weakening, pneumonia, and bedsores. Treatment for hip fractures aims to relieve pain and allow patients to return to their normal routines.

Non-surgical treatment of hip fractures, called closed reductionxf, requires no incisions. A closed reduction is typically performed for patients under five, those who cannot undergo surgery due to illness, and for fractures that are stable and may heal within days. Most often, surgery is recommended. Hip fracture surgery often entails one of the following procedures:

• Hip replacement, which can be partial or total. In this procedure, a surgeon replaces the damaged hip with artificial components, or prostheses.
• Open reduction, which is often performed with internal fixation (ORIF). To perform ORIF, a doctor will make an incision to expose the fracture and then move the bones back into proper position. Screws, pins, or plates - types of internal fixators - will be used to keep the bones in place.

Following surgery, patients may stay in the hospital for a few days or weeks. Additionally, patients may need crutches or a walker after their procedure, and their doctor may recommend limiting movement to avoid another hip injury. Physical therapy can help patients to avoid complications and return to normal activity.

Surgical treatments include the removal of inflamed tissue and joint reconstruction. The type of arthritis and severity of the damage will determine which treatment is most appropriate.