What is a hip fracture?

A hip fracture is a medical term for breaking the upper part of the thigh bone close to the hip joint.

Your femur is the longest and strongest bone in your body, so usually, it takes a serious fall, car accident or another type of trauma to break it. You'll almost certainly need surgery to repair a hip fracture.

A funny joke about broken hips helps people refer to a friend getting older. Such banter is usually intended for fun and games, but not forgotten in mind is that broken hips can be serious, life-changing injuries.

Types of hip fractures

Your hip is a ball-and-socket joint. The top of your femur is shaped like a ball (the head), which fits into a socket in your pelvis. A broken hip is a catch-all phrase that means any type of bone fracture to the upper part of your femur.

Healthcare providers sub-classify broken hips by where the femur breaks:

• Femoral head fractures: The femoral head is the rounded cap at your femur's top (proximal) end. It's extremely uncommon to crack your femoral head.
• Femoral neck fractures (subcapital or intracapsular fractures): The femoral neck is the bridge between your femur's rounded head and the long shaft running through your thigh. It's the most common place for hips to break.
• Intertrochanteric fractures: The greater and lesser trochanters are two bony bumps protruding on opposite sides of the femoral neck. Muscles and tendons attach to the trochanters. Intertrochanteric fractures occur when hip fractures break the space between these bony bumps.

Providers also may classify a hip fracture by the pattern of the fracture, meaning by the shape or direction of the break. These include:

• Transverse fractures.
• Oblique fractures.
• Spiral fractures.
• Comminuted fractures.

What are the symptoms of a hip fracture?

Most common symptoms for hip fractures include:

• Extreme pain in your hip.
• You can't move your hip or leg (immobility).
• You can feel or see a bump.
• Swelling.
• Bruising.
• Your hip changes shape and can be seen (deformity).

What causes hip fractures?

It usually takes a lot of trauma to break your hip. The most common causes of hip fractures are:

• Falls
• Car accidents.
• Sports injuries.

What is the risk?

Anyone can have an unexpected traumatic injury that results in a hip fracture; however, some populations are more susceptible to this than others. These include:

• Aged older than 65 years.
• Affected with conditions that weaken the bones
• People who are female by assignment.
• Athletes involved in contact sports.

You only need to fall some distance, like off a ladder or roof, to fracture your hip. However, in adults older than 65 or those suffering from other health conditions that weaken the bones, the chances of breaking a hip are much higher with minor slips and falls at home or even while going about one's daily routine.

Any medical condition that affects your balance, stability or gait can significantly increase your chances of breaking your hip. Some of the conditions that might affect your stability include:

• Parkinson's disease.
• Vertigo
• Abnormal gait.
• Epilepsy or any other medical condition that causes seizures.

How are doctors able to diagnose hip fractures?

A healthcare professional can diagnose a broken hip using physical examination, coupled with imaging tests. Your doctors in the emergency room are likely to diagnose the fracture in the ER if you have experienced a severe fall or any other form of trauma to the relevant body part.

At least one of the following types of imaging test will be used by your doctor to take pictures of your hip and the surrounding area to make a diagnosis:

• Hip X-ray.
• MRI (magnetic resonance imaging).
• CT scan (computed tomography scan).

What are the treatments for a hip fracture?

Most people with a hip fracture must have surgery. What kind of surgery you will need depends upon the severity and type of your fracture and any other injuries or conditions you may have. Of the following surgeries, two are most commonly done:

Hip replacement (hip arthroplasty): Adults over 65 with a hip fracture almost always need a hip replacement. You may have a total or partial replacement.

Open reduction and internal fixation (ORIF): Your surgeon will insert screws, pins or plates, or a metal rod into your femur to keep the pieces of your bone in place while they heal. Some people live with these fasteners in their bodies forever. Others need them removed once their hips heal.

Hip fracture surgery complications

Hip fracture surgery complications can include:

• Avascular necrosis: Avascular necrosis is the death of bone due to loss of blood supply to the bone for too long
• Nonunion: There is incomplete or failure to join your bone
• Malunion: This occurs when a broken bone heals in a misaligned position
• Bone infection (osteomyelitis): If you have an open fracture you're more likely to get infected from bacteria.

How do you prevent hip fractures?

You can't always prevent hip fractures because they are often caused by sudden falls or other trauma which cannot be planned for. However, to minimize the risk of falls and injuries, take the following general safety tips:

• Clear your home and work environment of clutter that could trip you up or other people up.
• If you are over 65 or if family members of your biological family have osteoporosis, discuss getting a bone density test with your provider.
• Follow an eating and physical activity plan that will maintain healthy bones.
• Use the right tools or equipment to access things in the home. Never stand on chairs, tables, or countertops.
• Always wear a seatbelt.
• Wear protective gear appropriate for the sport or activity.

How long does it take to get over a broken hip?

It can take at least a few months to fully recover from a broken hip. You'll begin to notice some change and even improvements over a year after treatment. How long it takes you to recover depends on numerous factors, such as:

• What type of surgery you required.
• Which other injuries you may have incurred.
• Your age.
• Your overall health.
• What caused the fracture.
• Your surgeon will prepare you beforehand, including what you can expect and even your personal recovery timeline.

You will begin PT shortly following surgery. You can start PT in as few days or weeks after the surgery. Depending on your situation, PT will likely be needed for months to regain mobility and walking. A physical therapist will give you some exercises and stretches that are to be done to strengthen the muscles around your hip.

You may have to use a walker, cane or crutches while you are recovering from the surgery. Some people need them for longer periods. Let your surgeon or physical therapist advice how long you should use mobility aids.

Why is the hip fracture particularly dangerous?

Hip fractures are emergencies. In addition to the damage to your femur and hip joint, hip fractures often occur with other significant injuries. This is particularly so in a serious fall or auto accident.

Any femoral fracture that compromises your integrity enough to cause a break in your femur may also compromise your integrity enough to cause damage to your femoral artery. This can be fatal if a provider does not treat it promptly because there's a potentially fatal amount of blood that may bleed out. If your hip is broken, you are also at an increased risk for blood clots.

The types of trauma that lead to hip fractures can be particularly devastating for those over the age of 65. The longer it takes your body to heal, the older you get, and that's particularly the case if you have a significant injury, such as a hip fracture. In this instance, surgery to repair a hip fracture (and healing from it) can also be harder on an older adult.

After recovery from a hip fracture, older adults aged 65 years or more have reported stopping or reducing the activities of walking and social activities and hobbies. Such isolation may become detrimental to their overall health. Ask your healthcare provider about how you can stay active after having a hip fracture. The provider may be able to facilitate finding ways to remain connected with loved ones and with activities that interest you.

Living With

When to Call the Emergency Room?

All hip fractures are medical emergencies. Call your local emergency services number if you suspect you have a broken hip. Call emergency services if you fall, are involved in a car accident or other trauma and you have any of the following symptoms:

• You cannot move your hip or leg.
• You have severe pain.
• Your hip or leg looks notably different, or is in an odd position.
• Bone can be seen through your skin.
• Your hip is noticeably swollen.
• You have significant bruising which starts simultaneously as one of the other symptoms.

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