Hip Fracture

A hip fracture is a break in the upper portion of the femur (thigh bone). Most hip fractures occur in elderly people whose bones have become weakened by osteoporosis. When hip fractures occur in younger people, it is usually from a traumatic event, such as a fall or motor vehicle accident (MVA). Hip fractures can occur in four separate areas of the femur and are identified according to how far the bone has moved from the original position. The four areas are the femur neck, the Intertrochanter area, the subtrochanteric area, and the femoral head. The intertrochanter and femoral neck fractures are the most common types of hip fractures. The femoral head fractures are extremely rare and are the result of a high impact traumatic event that may result in a fracture dislocation of the hip. Stress fractures are from repeated impact that occurs in the femoral neck.

Hip fractures are very painful, and signs and symptoms are presented in many ways. For example, a non-displaced hip fracture (bone has cracked but is not separated) of the femoral neck may not be painful at first. The patient may still be able to move the leg and bear weight even if painful. A minimally displaced fracture means that the bone has shifted along the break whereas a displaced fracture means that the bone has become completely detached. Occasionally, patients may not have symptoms at all. Symptoms of a fracture may include acute pain located in the groin and upper part of the thigh, swelling, bruising, and the hip may look deformed. Patients who present with these symptoms may not be able to stand, bear weight on the affected leg, or move the upper part of their leg or knee. Often, the affected leg may appear to be shorter than the opposite leg and will be twisted either internally or externally. Walking and standing may cause the fracture to spread, which will increase the pain significantly. The pain from a hip fracture can be so debilitating that patients may hurt too much to move and may become bed bound.

If you suspect either yourself or someone else of having a broken hip, please call 911 and go directly to the ER by ambulance. Treatment and workup will begin immediately by an ER physician and orthopedic surgeon. Images performed will include an X-ray to assess the bone structure and a magnetic resonance imaging (MRI) to assess possible tissue damage and undetected fractures not seen on the X-rays. A computer topography (CT) scan may be included to observe a detailed cross section image of the hip. Most surgeries will take place within 1 to 2 days of the injury. If the fracture is non displaced, then the injury may be treated without surgery in a healthy patient.

Recovery depends on the type of hip fracture and treatment. When pins and screws are required to secure the bone, the patient should try to resume walking with a walker as soon as the orthopedic surgeon permits. Treating the fracture and getting the patient out of the bed as soon as possible helps prevent medical complications such as bed sores, blood clots, and pneumonia. Prolonged bed rest makes rehab and recovery exceedingly difficult. Therefore, rehab begins after surgery. Some patients go home a few days after surgery and will receive home physical therapy until they are strong enough to go to therapy at an outside facility. Others, usually the elderly or patients who do not have a caregiver at home, will go to short-term care facilities for rehab and will stay until they can walk independently.