What Is It?
The hip is the joint between the upper end of the thighbone (femur) and its socket in the pelvis. When hip fractures occur, the injury is always in the femur. The upper end of the femur can fracture in any one of the following places:
- The head of the femur — The rounded surface at the very end of the bone that fits into a socket in the pelvis.
- The neck of the femur — A somewhat horizontal stretch of bone at the top of the femur that gives this bone the shape of an inverted “L”.
- Between or below the greater and lesser trochanters — The femur has a natural bend at the lower boundary of the hip, angling toward the knee. At this bend, two bony humps protrude along the outside edge of the femur. These ridges are the greater trochanter and lesser trochanter.
The most common cause of hip fractures is falls, usually in people older than 50. Older people are at risk of hip fractures as a result of osteoporosis, a decrease in bone strength that may be age-related. Hip fracture also may result from trauma, such as an automobile accident.
The severity of the fracture is determined by the degree to which the bone has moved from its original position (its displacement). Fractures can be:
- Nondisplaced, in which the bone has cracked but not separated
- Minimally displaced, in which the bone has shifted slightly along or away from a break
- Displaced, in which a part of the bone has become completely detached
A hip fracture can cause hip pain, swelling, bruising or a deformed hip appearance. Hip movement may be restricted, especially turning the foot outwards or bending at the hip. The fracture may make the hip seem too weak to lift the leg. People usually have pain in the groin when they put weight on the hip. Walking or even standing can cause the fracture to extend further, which may worsen the pain. In severe cases, a person with a hip fracture is in too much pain to move. In rare cases, usually in people who are bed-bound and do not put weight on their hips, a hip fracture may cause no symptoms.
If a hip fracture is suspected, an X-ray or magnetic resonance imaging (MRI) scan can confirm the diagnosis. Occasionally, additional X-rays are needed to spot small fractures, which become more visible on X-rays after one to two weeks.
The amount of time it takes to recover from a hip fracture depends on how the fracture is treated. When pins and screws are used to secure the bone, the person should try to resume walking with a walker as soon as possible. It may take six to eight weeks before the person can switch to walking with a cane. Recovering from hip-replacement surgery can take even longer, up to 12 weeks. In as many as two out of three cases, people with a hip fracture require long-term assistance with one or more basic daily activities. In up to 25 percent of cases, older people with hip fractures are no longer able to live independently even after they recover.
There are two main ways to prevent a hip fracture: Maintain bone strength, and prevent falls.
To optimize bone strength, men and women of all ages should exercise regularly and consume an adequate amount of calcium and vitamin D.
Women are especially susceptible to bone thinning as they age. A specialized X-ray test, called a bone mineral density test, measures bone strength. It can identify people with osteoporosis who would benefit from extra measures to promote bone health. After menopause, women with a family history of osteoporosis, a history of bone fracture as an adult, who weigh less than 127 pounds, or who smoke should consider having a bone mineral density test, according to the National Osteoporosis Foundation. Bone mineral density testing is advised for all women over age 65, with or without extra risks for osteoporosis.
If bone-density testing reveals that you have low bone strength, your doctor may recommend medication. A number of medications are available for the prevention of osteoporosis, including hormone-replacement therapy; bisphosphonates, including alendronate (Fosamax), risedronate (Actonel) and pamidronate (Aredia); and teriparatide (Forteo). Because hormone-replacement therapy may increase the risk of cardiovascular disease, it is no longer the first choice to prevent osteoporosis.
People who fall frequently should be evaluated by a doctor. Some causes of falling can be identified and treated. Falls can be prevented in some cases by improving home safety. Grab-bars, non-slip rug liners, adequate lighting and bedside toilet equipment may be helpful for some people. Your doctor can provide additional advice about how to prevent falls.
A relatively new strategy can help to prevent hip fractures even when falls do occur. If you have osteoporosis or have a history of hip fracture, you may consider wearing a pair of hip-protector pads. These shields have been shown to substantially reduce the risk of fracture when falls occur. They are worn daily, inside a specially designed undergarment.
Treatment depends on the location of the fracture, the degree of displacement, the number of other fractures and the age of the person. In general, a hip fracture usually is treated with surgery.
Fracture of the femoral head or neck — If the fracture is not displaced, the bones may be secured with pins and screws. Sometimes metal plates are used. Displaced fractures require hip replacement. In hip-replacement surgery, the damaged femoral head is replaced with a metal or ceramic ball, which fits into an artificial socket that is cemented in place.
Fracture between the trochanters — Anyone with a fracture between the two trochanters should undergo immediate treatment with traction, which involves the use of weights and pulleys to stretch and extend the muscles around the hip. Traction prevents the muscles attached to the trochanters from pulling the two sides of the fractured bone in different directions during the time it takes for the fracture to heal.
In someone who engaged in regular activity before an injury, traction should be followed by surgery to insert pins and screws in the hip to stabilize the broken bone. These patients should begin to move the joint as early as possible after the pins and screws are placed.
This type of surgery may be too traumatic for people who were bedridden before the fracture. In those cases, the fractured bone should continue to be immobilized. In these patients, immobilization may last four to eight weeks.
Fracture below the trochanters — Surgery for this type of fracture involves placing a long metal rod in the shaft of the thighbone to realign the break. In young children, traction and a full leg cast may be all that is needed.
When To Call A Professional
If you experience any hip pain after a fall, call your doctor for an urgent evaluation. If you suspect you may have fractured a hip, try to stay as still as possible and get help immediately.
Hip fractures are always serious. They are a major source of disability and can result in life-threatening complications. Approximately 4 percent of people die after a hip fracture, as a result of complications from the fracture, its surgical treatment or medical consequences from having to be immobilized. Immobility can cause blood clots to form in the leg veins, a problem that can lead to a life-threatening complication called pulmonary embolus. Pneumonia is also common in immobile patients. Immobility can cause bedsores in the buttock or ankle area, and bedsores can develop infections.
Hip fracture can cause sustained disability in many cases. However, in most cases, surgery is successful, and people can walk and resume normal activities with few restrictions.
Fractures of the femoral head can cause an additional complication by injuring the blood vessels that supply blood to the upper part of the femur. This type of injury can impair healing and lead to death of the bone, called osteonecrosis. Osteonecrosis of the femoral head occurs in 15 percent to 30 percent of people who fracture a hip.
Diseases and Conditions Center
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.