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Hip fractures are cracks in the top of the thigh bone (femur) where it meets the pelvis socket to form the hip joint. Risk factors include older age and female gender.
What is a 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 symptoms associated with hip fracture will 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.
Hip fracture symptoms
Hip fractures can cause various symptoms and associated complications listed below. However, not all of these symptoms have to be present.
- 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 the 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 rotate toward the side, 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 1–3% of people.
Long-term complications of hip fractures
Long-term complications of hip fractures can develop after injury or surgery, such as the following.
- Osteonecrosis: Displacement of the bone can disrupt the blood supply to the femoral head, cutting off the critical supply of oxygen and nutrients to the bone, causing bone tissue to die.
- A 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 condition is considered another long-term complication. Arthritis of the hip joint is common with aging, but an 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: Stiffness occurs especially after sitting or resting and will worsen in rainy weather.
- A locking or grinding feeling with 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 the 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 often affected?
Some people are at a higher risk for hip fractures.
- Older individuals: Hip fractures are most common in people older than 60 years of age.
- People prone to falls: Falls increase your risk of a hip fracture, especially if you have reduced balance, mobility, or vision.
- Women: Women are more 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% of hip fractures.
Certain conditions can also raise the risk of fractures.
- Gastrointestinal, metabolic, and nutrition disorders: These conditions lead to low vitamin D or calcium, which can cause weaker bones. Disorders of absorption (such as inflammatory bowel disease) or poor intake (such as anorexia nervosa) can also be causes.
- Neurologic conditions: These conditions include dementia and balance disorders. With these conditions, your risk of falling and subsequent fracture is increased by up to three times compared to someone without them.
Treatment options and prevention for hip fracture
Treating hip fractures will likely include a combination of pain control, surgery, and rehabilitation.
Following your fracture, your care team will try to control your pain. Nerve blocks or morphine injections near the joint may be used.
Surgery is the best treatment, in general, to reduce the duration of symptoms and avoid negative consequences of long bedrest (such as deconditioning, ulcers, and blood clots). Surgery is usually scheduled within 48 hours of your arrival to the hospital; however, it may be longer if you have other 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, surgeons may decide to replace the joint rather than repair the existing joint. The recommendation depends on factors such as the nature of the injury, your age, your mobility before the fracture, and your other medical conditions (such as 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 right for people who are too frail to recover. Conservative treatment, or pain management and bedrest, may benefit these people instead.
Physical therapy starts soon after surgical treatment of hip injuries.
- Duration: A physical therapist may evaluate you as soon as the day after surgery. After several sessions in the hospital, your therapists and surgeons will decide when it is safe for you to leave the hospital. Discharge can occur as soon as three to five days after the operation.
- Exercises: You and your physical therapist will decide realistic goals for your recovery and develop an exercise plan accordingly. This play may include weight-bearing exercises (such as walking), non-weight-bearing exercises (such as swimming), and balance exercises.
You can prevent a hip fracture entirely or reduce your risk with the following.
- Make sure your home is free of hazards: Hazards include loose carpets, cords, or other objects on the ground that may cause you to trip.
- Exercise regularly: Activity will help you improve 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: Using caution when standing will help you avoid lightheadedness or a loss of balance.
- Report dizziness and unsteadiness to your physician: These symptoms may be a result of medications you are taking or a treatable condition. Your physician may adjust your medication or provide a walker.
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 go to a hospital as soon as possible. Call an ambulance and try not to move while you are waiting. At the hospital, you will likely have to detail your fall and other medical conditions. Your care team may order X-rays or other imaging and provide pain control.
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
- 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?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Becker is a psychiatry resident at the Mount Sinai Hospital. He received his undergraduate degree in Urban & Regional Studies from Cornell University (2012) and completed his medical degree at the Perelman School of Medicine at the University of Pennsylvania (2018). Prior to medical school, he worked as a pre-medical teaching assistant at Weill Cornell Medicine-Qatar, where he received an Excellence in Teaching Award. His research has focused on global health (including explanatory models of mental illness in Botswana, epidemiology of head trauma, and psychosocial aspects of HIV), adolescent and young adult mental health, and quality improvement. He enjoys communicating health-related science through writing and teaching and joined Buoy Health as a writer in 2018. In his free time he enjoys running, hiking, and exploring new places.
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