Hip Fracture
What Is a Hip Fracture?
A hip fracture is a break in the upper part of the thigh bone (the femur). It is most common in older people whose bones have been weakened by osteoporosis, after a simple fall. In younger people it takes a high-energy injury such as a road-traffic accident or a fall from a height.
A hip fracture is very painful, prevents standing and walking and needs urgent assessment. Early treatment and getting moving again are important in preventing complications such as clots, chest infection and pressure sores. For other hip problems you can review the hip page.
Types of Hip Fracture
Hip fractures are classified by their location at the top of the femur; this directly determines the method of treatment and the expected recovery.
- Femoral neck fractures: just below the femoral head. Because the blood supply to the femoral head is at risk in this region, a replacement is more often considered in displaced fractures.
- Intertrochanteric fractures: in the broad area between the femoral neck and the shaft; usually fixed with a nail or a plate and screws.
- Subtrochanteric fractures: in the upper femur just below the trochanters; most often fixed with an intramedullary nail.
- Femoral head fractures: rare, and usually seen with high-energy injuries together with a hip dislocation.
Causes and Risk Factors
Hip fractures are seen in two different groups of patients through different mechanisms; this distinction affects the treatment and the overall approach.
- Low-energy falls in older people: bone weakened by osteoporosis can break with a simple fall or sometimes even while walking.
- High-energy trauma in younger people: road-traffic accidents and falls from a height.
- Stress fractures: can appear as gradually increasing groin pain with repetitive loading such as long-distance running.
- Conditions that weaken bone: older age, female sex, a previous fracture, certain medications and bone tumours raise the risk.
Symptoms
In a displaced hip fracture the symptoms are obvious; in stress fractures the pain can begin insidiously and increase over time.
- Severe pain in the groin and upper thigh, an inability to stand and an inability to bear weight on the leg.
- The injured leg appearing shorter and turned outwards compared with the other.
- Swelling, bruising and tenderness at the site of the fall.
- In a stress fracture, groin pain that increases with weight-bearing and eases with rest.
Emergency Assessment
A hip fracture, especially in older patients, requires not just the bone but the whole patient to be addressed. The reason for the fall (a drop in blood pressure, a heart-rhythm problem, a medication side effect) is looked into and accompanying injuries are assessed.
The blood supply and nerves of the leg are checked, pain is controlled and the patient is prepared for surgery. Protection against clots related to immobility is planned early; the deep vein thrombosis page gives general information on this.
Diagnosis: Examination and Imaging
A fall is not the only cause of hip pain; a groin strain, hip bursitis and a flare of existing hip arthritis can cause similar pain. But if no weight can be borne and the leg is short and turned outwards, a fracture is considered first and imaging is always performed.
- X-ray: most hip fractures are seen directly and the type of fracture is determined.
- CT: supports the detail of the fracture and surgical planning.
- MRI: can show a hidden or stress fracture not seen on X-ray.
Surgical Treatment and Methods
The large majority of hip fractures are treated with surgery; surgery makes early movement possible and so reduces complications. When the patient's general condition allows, the operation is aimed to be performed as soon as possible. The method is chosen according to the type of fracture and the patient's condition.
- Femoral neck fractures: fixation with screws in a non-displaced fracture; a partial (hemiarthroplasty) or total hip replacement in a displaced fracture, especially in older patients.
- Intertrochanteric and subtrochanteric fractures: fixation with an intramedullary nail or a sliding hip screw and plate.
- In non-displaced, stable fractures, non-surgical management with controlled weight-bearing may be considered in selected cases.
Recovery and Rehabilitation
Getting moving early after surgery is one of the most important parts of treatment. Most patients are helped to their feet in the early period, to the extent the doctor allows, according to the type of fracture and the fixation used.
Physiotherapy aims to strengthen the leg muscles, restore safe walking and return the patient to daily activities. In older patients, reducing the risk of falls and reviewing osteoporosis treatment are also included in the plan to preserve independence after the fracture.
Prevention
In older people in particular, a proportion of hip fractures can be prevented by reducing the risk of falls and bone weakness.
- Screening for osteoporosis and treating it on medical advice; adequate calcium, vitamin D and a balanced diet.
- Regular exercise that improves balance and muscle strength; reducing fall hazards at home (slippery floors, poor lighting, rugs).
- Checking vision, wearing suitable footwear and reviewing medications that can cause dizziness.
When Should You See a Doctor?
Any suspected hip fracture is an emergency and needs assessment without delay.
- After a fall there is severe groin pain, an inability to bear weight on the leg or a short, turned-out leg; go to the emergency department.
- An older patient complains of the hip after a fall; even if the X-ray looks normal, further imaging may be needed for a hidden fracture.
- A long-distance runner has gradually increasing groin pain; this should be assessed for a stress fracture.
For treatment and follow-up after a fracture you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within hip surgery.