In a hip fracture, the upper portion of the femur (thighbone) is broken. The majority of hip fractures occur in elderly patients whose bones have become weak due to osteoporosis. Most hip fractures in young patients occur from traumatic events such as falls from ladders or vehicle collisions.

In the United States, more than 300,000 people sustain a hip fracture every year. The majority of these fractures occur in individuals over the age of 65 who have fallen in or near their home.

The pain associated with a hip fracture is severe. It is therefore advisable to seek surgical treatment as soon as possible. Preventing medical complications such as bed sores, blood clots, and pneumonia will be easier if the fracture is treated promptly and the patient is out of bed as soon as possible. Additionally, an extended period of bed rest may also result in disorientation in very elderly patients, making it difficult for them to perform rehabilitation or recover.

Unlike the knee, the hip is a ball-and-socket joint. Femurs are made up of a ball called the head, which is the upper part of the thighbone. The socket is known as the acetabulum. Acetabulums form part of the pelvic bone. It is rounded to fit around the femoral head.

Four Types of Hip Fractures

Femoral Neck Fractures
Occur just below the ball of the ball-and-socket hip joint, a portion of the femur just below the ball (femoral head).

Intertrochanteric Fractures
The region below the neck of the femur and above the shaft or long part of the femur. The intertrochanteric area contains two skeletal landmarks: the greater trochanter and the lesser trochanter.

Subtrochanteric Fractures
The upper part of the femur shaft that sits just below the greater and lesser trochanters.

Femoral Fractures
The ball of the femur that rests in the socket.

There are two types of hip fractures most commonly found: femoral neck and intertrochanteric fractures. Fractures of the femoral head are extremely rare and usually are the result of a high-velocity event like a car crash.

Low-energy falls are commonly responsible for hip fractures in elderly patients who have osteoporotic or weakened bones. An accident as simple as a tripping or twisting can lead to a fracture.

There are some cases in which the bone may be so weak that it spontaneously fractures while walking or standing. It is often said that spontaneous fractures occur before the fall happens. In this instance, they typically occur in the femoral neck.

In the femoral neck, there is also the possibility of a stress fracture or repetitive impact fracture. Runners in general, especially those in basic training, are susceptible to fractures like these. It has been shown that prolonged use of certain osteoporosis medications is often associated with stress fractures of the subtrochanteric hip.

It is rare to suffer a fracture of the femoral head, and they usually accompany high-impact injuries to the hip or as part of a fracture dislocation.

Hip fractures are typically extremely painful. In most cases, the pain is located in the thigh and the upper part of the groin. Often, a hip fracture leaves the patient unable to stand or bear weight, nor move the upper leg or the knee. If your lower leg is not injured in addition to your hip, you will be able to move your ankle and toes.

Although you may be able to bear part of your weight on your leg with some fractures, you will experience severe pain.

Surgery is typically required within one to two days of suffering a hip fracture. Among healthy patients, only a small number of non-displaced fractures can be treated without surgery, while a separate group of patients may be too sick to undergo surgery.

In order for the patient to be able to get out of bed, he or she must undergo surgical treatment to relieve the acute pain from the fracture. The sooner surgery is performed, the lower the risk of complications.

In addition to the type and location of a hip fracture, the patient’s age and health determine the treatment. Your surgeon will review x-rays and possibly other medical scans and patient history before discussing your treatment options.

Common Symptoms

• Severe pain in the hip or groin
• Inability to put weight on the injured leg
• Stiffness, bruising, and swelling around the hip area
• Leg appearing shorter on the injured side
• Leg turning outward on the injured side

Causes & Anatomy

• Falls: Especially in older adults with weakened bones due to osteoporosis.
• Direct trauma: Such as car accidents or sports injuries.
• Weak bones: Conditions like osteoporosis or cancer can weaken bones, making them more susceptible to fractures.
• Stress fractures: Repeated stress or overuse can lead to tiny cracks in the bone, which can progress to a complete fracture.

Anatomy of the Hip:

• Femur: The thigh bone, particularly the proximal end (near the hip joint).
• Femoral neck: The narrow section of the femur just below the ball of the hip joint.
• Intertrochanteric region: The area between the femoral neck and the shaft of the femur.
• Pelvis: The hip socket (acetabulum) which articulates with the femoral head.

Prevention

• Fall prevention: Using assistive devices, ensuring a safe living environment, and addressing balance issues.
• Bone health: Adequate intake of calcium and vitamin D, and medications to strengthen bones if needed.
• Regular exercise: Weight-bearing and muscle-strengthening exercises to maintain bone density and muscle strength.

Treatment

• Non-surgical treatment: Typically for non-displaced fractures or patients who are not good candidates for surgery. May include bed rest and pain management.
• Surgical treatment: Most hip fractures require surgery to allow for proper healing and mobility.
• Internal fixation: Using metal screws, rods, or plates to hold the bone together.
• Hip replacement: Partial or total replacement of the hip joint, especially in cases of severe damage or in older adults with poor bone quality.

Surgery

• Hip pinning (internal fixation): Metal screws are used to hold the fractured bone together.
• Partial hip replacement (hemiarthroplasty): Replacing the femoral head and neck with a prosthesis.
• Total hip replacement (arthroplasty): Replacing both the acetabulum and the femoral head with prosthetic components.

Rehabilitation

• Physical therapy: To restore movement, strength, and flexibility.
• Weight-bearing exercises: Gradually reintroducing weight-bearing activities as tolerated.
• Occupational therapy: To help with daily activities and ensure a safe home environment.
• Pain management: Medications and other therapies to manage post-surgical pain.

Frequently Asked Questions

How long does it take to recover from a hip fracture?
Recovery time varies but generally takes several months. Full recovery, including rehabilitation, can take up to a year.

What are the risks of surgery for hip fractures?
Risks include infection, blood clots, hip dislocation, and complications related to anesthesia.

Can hip fractures heal without surgery?
Non-displaced or stable fractures might be treated without surgery, but most hip fractures require surgical intervention for proper healing.

How can I prevent hip fractures if I have osteoporosis?
Maintain bone health through diet, exercise, and medications as prescribed. Prevent falls by creating a safe living environment and using assistive devices if needed.

Are there long-term effects of a hip fracture?
Possible long-term effects include chronic pain, decreased mobility, and an increased risk of future fractures.