What Is Hip Fracture?
Hip fractures are cracks in the top of the thigh bone (femur) near where it meets the pelvis socket (acetabulum) to form the hip joint. They commonly occur due to a fall or a direct blow to the hip .
Symptoms include groin pain, an inability to walk or put weight on the affected leg, knee pain, an inability to fully lift the leg, bruising and swelling, and visible deformity of the leg. Not all associated symptoms of hip fracture will necessarily be present for this condition to be confirmed.
Treatments include pain control, surgery, and rehabilitation.
You should seek immediate medical care at an urgent care clinic or ER as complications can become life-threatening. Treatment involves a combination of surgery, rehabilitation and medication.
How common is Hip Fracture?
Symptoms that always occur with Hip Fracture:
- Hip pain from an injury
- Constant hip pain
Hip Fracture is also known as
- Femoral neck fracture
- Femoral head fracture
- Subcapital fracture
- Intertrochanteric fracture
- Subtrochanteric fracture
Hip Fracture Symptoms
Hip fractures can cause various symptoms and associated complications listed below. However, not all of these symptoms have to be present for a hip fracture to have occurred.
- Groin pain: This is the most common hip fracture symptom.
- Inability to walk or put weight on leg: Many people with hip fractures find it very difficult to walk without pain; however, in minor and non-displaced injuries, walking with only mild pain is possible.
- Knee pain: Due to the organization of the body's nerves, pain may be felt more severely in the knee (referred pain), even if injury occurred in the hip.
- Inability to fully lift leg: This inability will occur with the knee straightened.
- Bruising and swelling: The hip area may present with bruising and swelling.
- Visible deformity: If a displaced fracture occurs, the fractured leg may appear shorter and rotated toward the side, when compared to the uninjured leg.
Short-term complications of hip fractures
Certain complications of hip fractures can develop soon after injury or surgery, including:
- Bedsores (pressure ulcers): If you are immobilized in bed or a chair for a long time, the skin can break down and become painful.
- Blood clots (deep venous thrombosis): Immobilization can lead to blood clots. These often form in your legs, which can be painful, and may be deadly if they become dislodged from the legs and travel to the lungs (pulmonary embolism). Clotting can be prevented by movement, wearing special stockings, and medications.
- Infection: Modern sterile surgical techniques and antibiotics have greatly reduced the risk of infection from operations; however, postoperative infections still develop in 1 to 3 percent of people .
Long-term complications of hip fractures
Certain long-term complications of hip fractures that can develop after injury or surgery include:
- Osteonecrosis: Displacement of the bone can disrupt blood supply to the femoral head, cutting off critical supply of oxygen and nutrients to the bone, causing bone tissue to die.
- Fracture fails to heal (fracture nonunion): Although many fractures heal without problems, sometimes bone fails to heal due to inadequate stability or blood supply.
Symptoms of osteoarthritis
This is considered another long-term complication. Arthritis of the hip joint is common with aging, but injury to the hip can increase your chances of developing arthritis. Symptoms include:
- Pain in the thigh: This pain will also spread to the buttocks and knee
- Pain and stiffness: This occurs especially after sitting or resting and will worsen in rainy weather
- Locking and grinding of the joint during movement
- Decreased range of motion of the hip
Hip Fracture Causes
Fractures can occur at any of the locations of the femur, including the head, neck, and prominences (trochanters) at the other end of the bone. The neck and trochanters are most common sites of injury. There are certain characteristics that predispose some people to hip fractures, as well as certain medical conditions.
Who is most likely to be affected
Some people are at a higher risk for hip fractures, including:
- Older individuals: Hip fractures are most common in people older than 60 years .
- Those prone to falls: Falls create an increased risk of a hip fracture, especially in people with reduced balance, mobility, or vision.
- Women: Women are more commonly affected by hip fractures than men due to low bone density (osteoporosis) that occurs after estrogen levels fall during menopause. As a result, women experience 70 percent of hip fractures .
Certain conditions can also raise the risk of fractures. These include:
- Gastrointestinal, metabolic, and nutrition disorders: These lead to low vitamin D or calcium, which can cause weaker bones . This can involve disorders of absorption (such as inflammatory bowel disease) or poor intake (such as anorexia nervosa).
- Neurologic conditions: This includes dementia and balance disorders, which can increase the risk of falling and subsequent hip fracture by up to three times compared to someone without these conditions .
Treatment Options and Prevention for Hip Fracture
Treating hip fractures will likely include a combination of pain control, surgery, and rehabilitation.
In the period between fracturing the hip and surgery, medical teams try to control pain. This can be done with nerve blocks,injection of pain medicine near the joint to control pain in the affected area and medications such as morphine .
Surgery is generally considered the best treatment, to reduce the duration of hip injury symptoms and avoid the negative consequences of long bedrest (such as deconditioning, ulcers, and blood clots). Surgery is generally planned within 48 hours of arrival to the hospital but may be delayed if you have other unstable medical conditions. Surgical methods include:
- Open reduction and internal fixation (ORIF): In an operating room under general or epidural anesthesia, surgeons will expose the broken bone and fix the fracture with plates, screws, and rods. These place the bone into the ideal position to heal.
- Femoral head or total hip replacement (arthroplasty or hemiarthroplasty): In about half of cases, the surgeons may decide that you may benefit from replacement of the joint rather than simply repairing the existing joint. The treatment recommendation depends on factors such as the nature of the injury, your age, your mobility before the fracture, and your other medical conditions (e.g., osteoarthritis). In these cases, your surgeon may recommend replacing part of or the entire hip with artificial (prosthetic) materials, usually made of metal or ceramic.
Alternatives to surgery
Surgery is recommended for most people . However, surgery may not be recommended for individuals who are too frail to be able to recover. Instead, conservative treatment (pain management and bed rest) may be recommended.
Physical therapy is started quickly after surgical treatment of hip injuries other details include:
- Duration: You may be evaluated by physical therapists as soon as the day after your surgery. After several physical therapy sessions in the hospital, your therapists and surgeons will agree on when it is safe for you to be discharged from the hospital. This can be as soon as three to five days after the operation.
- Exercises: You and your physical therapist will agree upon realistic goals for your recovery and develop a plan of exercises to help you reach these goals. A good rehabilitation plan is associated with quality of life. It may include weight-bearing exercises (such as walking), non-weight-bearing exercises (such as swimming), and balance exercises.
Preventing Hip Fractures
Hip fractures can be prevented entirely or are less likely to occur by taking the following precautions :
- Make sure your home is free of hazards: This includes loose carpets, cords, or other objects on the ground, that could cause you to trip and fall.
- Exercise regularly: This will improve or maintain your strength and balance.
- Correct any vision problems
- Avoid excessive drinking and smoking: These habits have a negative impact on bone tissue.
- Stand up slowly: Thiswill help you avoid lightheadedness that could cause you to lose balance.
- Report dizziness and unsteadiness to your physician: These symptoms may be a result of medications you are taking or a treatable medical condition. Your physician may be able to help through medication adjustments or providing a walker to help you move about safely.
When to Seek Further Consultation for Hip Fracture
You should seek medical attention any time you suffer an injury to your hip or leg, or experience significant pain in these areas.
If you have fallen and experience hip or knee pain
If you think you might have broken your hip, it's best to be evaluated at a hospital as soon as possible. Call an ambulance and try to move as little as possible while you are waiting. At the hospital, they will likely ask you about the fall and other medical conditions, order X-rays or other imaging to evaluate the bone, and control your pain as you wait for possible treatment.
If you have had a recent hip fracture and develop shortness of breath or new pain or swelling in your lower leg
Immobilization after fractures and major surgeries raises your risk for developing blood clots in your leg. These will usually lead to pain and swelling on the affected side, likely in your lower leg, as well as shortness of breath. If you experience these symptoms, it is important to report them to your physician. Untreated clots can lead to pulmonary embolism, which can be a deadly condition.
If you develop a fever and worsening pain or drainage at the surgical site
Report these symptoms to your surgical team, as they may be signs of postoperative infection that require further treatment.
Questions Your Doctor May Ask to Determine Hip Fracture
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Is your knee pain getting better or worse?
- How would you explain the cause of your knee pain?
- How severe is your knee pain?
- How long has your knee pain been going on?
- Is your knee pain constant or come-and-go?
The above questions are also covered by our A.I. Health Assistant.
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