Hip Fracture

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

Main 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.

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.

Medical conditions

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.

Pain control

Following your fracture, your care team will try to control your pain. Nerve blocks or morphine injections near the joint may be used.

Surgery

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 bed rest, may benefit these people instead.

Here are some supportive over-the-counter (OTC) options that can help manage symptoms associated with the injury:

Pain Relievers: Acetaminophen can help manage pain without the risk of bleeding that comes with NSAIDs, which is crucial if surgery is planned.

Topical Analgesics: For those who prefer not to take oral medications, topical pain relievers like diclofenac gel can be applied directly to the skin around the hip (avoiding the fracture site) to reduce pain.

Supplements: Calcium and vitamin D supplements can support bone health, which is vital for both recovery and prevention of further bone issues.

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.