Hip Fracture

A hip fracture is a break in the upper quarter of the femur (thigh bone), which forms part of the hip joint. Hip fractures are serious injuries that most commonly affect older adults, particularly those with osteoporosis, and typically require surgical intervention. There are different types of hip fractures based on the specific location of the break: femoral neck fractures occur just below the ball portion of the hip joint; intertrochanteric fractures occur below the femoral neck in the area between the greater and lesser trochanters; and subtrochanteric fractures occur below the lesser trochanter in the upper part of the femoral shaft. Each type may require different surgical approaches. Hip fractures can significantly impact mobility and independence, with complications including blood clots, pressure sores, pneumonia, and, in some cases, can lead to life-threatening conditions. Prompt treatment and comprehensive rehabilitation are essential for the best possible outcomes.

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CausesSymptomsDiagnosisTreatmentHome CarePreventionSurgery

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What Causes It?

Falls - The most common cause, especially in older adults. Even a fall from standing height can fracture the hip in someone with weakened bones.

Osteoporosis - A condition that weakens bones, making them more susceptible to breaking even with minimal trauma.

Age-related bone loss - Natural decrease in bone density that occurs with aging, even without osteoporosis.

Gender - Women experience more rapid bone loss after menopause and have a higher risk of hip fractures.

Inadequate nutrition - Deficiencies in calcium and vitamin D can contribute to bone weakness.

Physical inactivity - Lack of weight-bearing exercise contributes to bone loss and muscle weakness.

Medications - Certain drugs, such as long-term corticosteroids, can weaken bones.

Medical conditions - Disorders affecting balance, vision, blood pressure, or causing seizures can increase fall risk.

High-impact trauma - In younger individuals, hip fractures typically result from high-energy trauma like car accidents or falls from height.

Stress fractures - Repetitive activities, particularly in athletes, can cause stress fractures that may progress to complete fractures if untreated.

Cancer - Metastatic cancer or certain types of bone cancer can weaken the femur, leading to pathological fractures.

Smoking and excessive alcohol consumption - Both contribute to bone loss and increased fracture risk.

Signs & Symptoms

Severe pain in the hip or groin area, especially with movement.

Inability to bear weight on the affected leg or stand up after a fall.

Visible deformity, with the injured leg appearing shorter and often externally rotated (turned outward).

Bruising, swelling, and tenderness around the hip area.

Limited mobility and inability to move the hip or upper leg.

Pain that radiates to the knee (referred pain, which can sometimes be more noticeable than hip pain).

Stiffness, muscle spasms, and difficulty moving the hip joint.

In some cases, particularly with impacted fractures, patients may still be able to bear some weight, leading to delayed diagnosis.

Symptoms of shock may be present, including rapid heartbeat, low blood pressure, and confusion, especially in elderly patients.

Note: In older adults with dementia or communication difficulties, a hip fracture may present primarily as refusing to walk, sitting differently, or showing agitation when moved.

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Physical Examination

The doctor will check for external rotation of the leg (turning outward), shortening of the affected leg, pain with movement, and inability to bear weight. These signs strongly suggest a hip fracture, but imaging studies are needed for confirmation.

X-rays

The primary diagnostic tool for hip fractures, showing the location and type of fracture. Standard views include anteroposterior (AP) and lateral views of the hip. Sometimes, especially with nondisplaced fractures, the fracture line may not be immediately visible.

MRI (Magnetic Resonance Imaging)

May be ordered when X-rays are negative but a hip fracture is still suspected. MRI can detect subtle fractures, stress fractures, and soft tissue injuries not visible on X-rays. It's particularly valuable for diagnosing occult hip fractures (those not visible on initial X-rays).

CT Scan (Computed Tomography)

Provides detailed cross-sectional images that can help diagnose fractures not clearly visible on X-rays and assist in surgical planning by showing the fracture pattern in three dimensions.

Bone Scan

May be used if other imaging is inconclusive. A radioactive tracer is injected and accumulates in areas of increased bone activity, which can reveal fractures not visible on X-rays. However, this test is less specific and takes longer to complete than MRI.

Laboratory Tests

Blood tests to assess overall health status, check for infection, evaluate kidney and liver function, assess coagulation, and determine hemoglobin levels, all of which may influence treatment decisions and surgical planning.

Pre-operative Assessment

Comprehensive evaluation of cardiovascular, respiratory, and overall health status to assess surgical risks and optimize the patient for surgery, which may include electrocardiogram, chest X-ray, and various blood tests.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

1

Surgical Treatment

The standard of care for most hip fractures, with the specific approach depending on the fracture type, patient age, bone quality, and other factors. Options include internal fixation (using screws, pins, rods, or plates to hold the bone together), partial hip replacement (replacing the femoral head), or total hip replacement (replacing both the femoral head and acetabulum). Surgery is typically performed within 24-48 hours of injury when medically feasible.

2

Non-Surgical Management

Rarely used and typically only considered for non-displaced fractures, patients who are non-ambulatory before the fracture, or those with extremely high surgical risks. This approach involves bed rest, pain management, and potentially traction, with a high risk of complications and poor functional outcomes for most patients.

3

Pain Control

Essential both before and after surgery, may include opioid and non-opioid medications, nerve blocks, positioning, ice therapy, and eventually non-pharmacological approaches like physical therapy. Multimodal pain management is typically used to minimize opioid requirements.

4

Early Mobilization

Getting patients out of bed and moving as soon as possible after surgery (often the day after) to prevent complications like blood clots, pneumonia, pressure sores, and deconditioning. Physical therapists guide weight-bearing status and safe movement techniques.

5

Rehabilitation

Structured program of physical and occupational therapy to restore mobility, strength, and independence. May begin in the hospital and continue in a rehabilitation facility, skilled nursing facility, or at home, depending on the patient's needs and resources.

6

Osteoporosis Treatment

For fractures related to osteoporosis, medications to increase bone density and prevent future fractures are essential. Options include bisphosphonates, denosumab, teriparatide, or other bone-strengthening medications, along with calcium and vitamin D supplementation.

7

Fall Prevention

Comprehensive assessment of fall risk factors and interventions to prevent future falls, which may include home safety evaluation, vision assessment, medication review, balance training, and appropriate assistive devices like walkers or canes.

Home Remedies

Follow Weight-Bearing Instructions

Adhere strictly to your surgeon's guidelines about how much weight you can put on the affected leg. This may range from no weight-bearing to partial or full weight-bearing, depending on the fracture type and fixation method. Using appropriate assistive devices (walker, crutches, cane) correctly is essential.

Home Adaptation

Prepare your living space before returning home from the hospital. Remove tripping hazards like loose rugs and cords, install grab bars in the bathroom, consider a raised toilet seat and shower chair, and arrange frequently used items within easy reach to avoid bending or stretching.

Pain Management

Take prescribed pain medications as directed, transitioning to over-the-counter options as pain improves. Ice packs (wrapped in a thin towel) applied for 15-20 minutes several times daily can help reduce pain and swelling, especially in the first few weeks after surgery.

Nutrition for Healing

Consume adequate protein (1.2-1.5 g/kg body weight daily) to support tissue repair. Ensure sufficient calcium (1200 mg daily for older adults) and vitamin D (800-1000 IU daily) intake through diet and supplements as recommended by your doctor. Stay well-hydrated to support overall health and prevent constipation from pain medications.

Prevent Complications

Perform deep breathing exercises regularly to prevent pneumonia. Move ankles and unaffected limbs frequently to improve circulation and reduce blood clot risk. Change positions carefully but regularly to prevent pressure sores. Use prescribed blood thinners exactly as directed if ordered after surgery.

Exercise Appropriately

Perform the specific exercises prescribed by your physical therapist, which typically start with gentle ankle pumps, quadriceps sets, and gluteal squeezes, progressing to more advanced exercises as healing occurs. Never attempt exercises beyond those approved by your healthcare team.

Wound Care

Keep the surgical incision clean and dry according to your surgeon's instructions. Typically, this means avoiding immersion in water (baths, swimming pools) until the wound is fully healed. Report any signs of infection (increased redness, warmth, swelling, drainage, or fever) immediately.

Rest and Sleep

Ensure adequate rest to support healing, aiming for 7-9 hours of sleep nightly. Finding comfortable sleeping positions can be challenging; pillows placed strategically (between the legs when side-lying, under the knees when on your back) can help maintain proper alignment and reduce discomfort.

Prevention Tips

Get screened for osteoporosis if you're a woman over 65, a man over 70, or have risk factors at younger ages.

Maintain adequate calcium intake (1,000-1,200 mg daily) and vitamin D (600-800 IU daily) through diet and supplements if needed.

Engage in regular weight-bearing and resistance exercises to strengthen bones and improve balance.

Perform balance exercises like tai chi to reduce fall risk.

Make home safety modifications including removing tripping hazards, improving lighting, and installing grab bars in bathrooms.

Have vision and hearing checked regularly, as sensory impairments increase fall risk.

Review medications with your doctor regularly, as some can cause dizziness or affect balance.

Use assistive devices like canes or walkers if recommended for stability.

Wear properly fitting, low-heeled shoes with non-slip soles.

Be cautious on wet or icy surfaces, and consider using ice grips on footwear during winter.

Stand up slowly from sitting or lying positions to prevent orthostatic hypotension (sudden blood pressure drop).

Consider hip protectors (specialized underwear with padding) for those at very high risk.

Address hazards immediately, such as cleaning up spills or moving obstacles in walkways.

Maintain healthy blood pressure, as both high and low readings can increase fall risk.

Avoid excessive alcohol consumption, which affects balance and coordination.

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Internal Fixation

For femoral neck fractures that are nondisplaced or minimally displaced, and for most intertrochanteric and subtrochanteric fractures. This approach preserves the patient's own hip joint while stabilizing the fracture. Multiple screws, sliding hip screws with side plates, or intramedullary nails may be used, depending on the fracture pattern. The procedure involves making incisions to access the fracture site, reducing (realigning) the fracture, and securing it with metallic implants.

Hemiarthroplasty (Partial Hip Replacement)

Commonly used for displaced femoral neck fractures in older patients. The femoral head and neck are removed and replaced with a prosthesis (artificial component), while the acetabulum (socket) remains intact. This procedure eliminates concerns about the femoral head losing its blood supply and developing avascular necrosis, a common complication with certain fracture patterns. It allows for immediate weight-bearing and quicker rehabilitation.

Total Hip Arthroplasty (Total Hip Replacement)

Considered for displaced femoral neck fractures in active patients with longer life expectancy, patients with pre-existing arthritis, or when the acetabulum is damaged. Both the femoral head/neck and the acetabular socket are replaced with prosthetic components. This provides excellent pain relief and function but carries slightly higher risks of dislocation and requires more extensive surgery than hemiarthroplasty.

Cephalomedullary Nailing

The preferred treatment for unstable intertrochanteric fractures and subtrochanteric fractures. A specialized intramedullary nail is inserted through the top of the greater trochanter down into the femoral canal, with screws extending from the nail into the femoral head to provide rotational stability. This load-sharing device allows for earlier weight-bearing and has mechanical advantages for certain fracture patterns.

Revision Surgery

May be necessary if the initial fixation fails, the fracture doesn't heal properly, or complications develop. Options range from re-fixing the fracture with different hardware to converting to a partial or total hip replacement. These procedures are typically more complex than the initial surgery and carry higher risks of complications.

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