What You Need to Know About Hip Fractures

A hip fracture is a break in the upper part of the femur, near the hip joint. Most commonly seen in older adults after a fall, these injuries often require surgery and a structured recovery plan.

In this post, I’ll explain the causes, types, symptoms, diagnosis, and treatment options for hip fractures.

• Hip fractures, categorized as intracapsular or extracapsular, require precise identification for effective treatment and recovery.
• Common causes include low-energy falls, particularly in older adults with osteoporosis. Risk factors include age, gender, and certain medical conditions.
• Early diagnosis, treatment, and a postoperative care plan are essential for recovery and reducing long-term complications.

A hip fracture, often called a ‘neck of femur fracture,’ is a break in the upper part of the femur, near the hip joint. The hip joint is a ball-and-socket structure, where the head of the femur fits into the acetabulum of the pelvis. Recognizing this anatomy is important because the location of the break—whether in the neck of the femur, the area just below it (intertrochanteric), or farther down (subtrochanteric)—dictates the treatment and recovery process.

Hip fractures are categorized into two broad categories:

• Intracapsular fractures: These occur within the joint capsule and include femoral neck fractures.
• Extracapsular fractures: These occur outside the capsule and include intertrochanteric and subtrochanteric fractures.

Each type presents unique challenges and requires specific management strategies for proper healing and recovery.

Low-energy falls, often from standing height, are the leading cause of hip fractures in older adults. Individuals with osteoporosis, a condition that weakens bones, are at especially high risk. Osteoporosis significantly decreases bone density, making fractures more likely even from minor impacts.

In younger adults, hip fractures are more often linked to high-energy trauma, such as car accidents.

Recognizing these causes underscores the need for preventive measures and timely interventions to reduce the risk and impact of hip fractures.

Age and gender are significant risk factors for hip fractures. Bone density tends to decrease with age, making older individuals more susceptible to fractures. Women experience hip fractures about three times more frequently than men, in part due to hormonal changes after menopause that accelerate bone density loss. Medical conditions like osteoporosis and thyroid issues further increase this risk.

Certain medications, especially long-term cortisone use, can weaken bones, increasing the risk of a fracture. Lifestyle factors, such as lack of exercise, poor nutrition, and the use of tobacco or alcohol, also impair bone health.

Regular exercise, especially activities that improve balance, along with adequate nutrition, helps mitigate these risks. Tailored exercise programs can enhance muscle strength and reduce the likelihood of falls.

Identifying the symptoms and signs of a hip fracture is key for timely diagnosis and treatment. Sudden hip pain, often paired with severe discomfort in the hip or groin area, is a primary indicator. Additionally, the affected leg may appear shorter or turn outward.

The inability to stand or walk after a fall is a major red flag. Visible bruising and swelling around the hip region are also common signs.

Early recognition of these symptoms can lead to quicker diagnosis and timely intervention.

Diagnosing a hip fracture begins with a physical examination by an experienced orthopedic surgeon, combined with imaging tests. The surgeon will assess symptoms and leg positioning (such as external rotation or shortening).

X-rays are often the first imaging test performed, with cross-table lateral and anteroposterior pelvis views.

In some cases, if fractures are not visible on X-rays despite ongoing pain, advanced imaging like magnetic resonance imaging (MRI) or bone scans may be necessary.

These imaging tests, combined with physical examination results, enable an accurate diagnosis and treatment plan.

Hip fractures occur in distinct anatomical regions of the upper femur, each requiring specific treatment strategies. The three main types are femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures.

Femoral neck fractures occur at the neck of the femur, just below the ball of the hip joint. These fractures are classified as either a displaced femoral neck fracture, where the bone fragments have moved out of alignment, or non-displaced, where the bone fragments remain aligned.

Intertrochanteric fractures occur between the greater and lesser trochanters, approximately three to four inches from the hip joint. These fractures are generally classified as stable or unstable based on their pattern. Unlike femoral neck fractures, intertrochanteric fractures typically do not disrupt blood flow to the femur.

Subtrochanteric fractures occur just below the lesser trochanter of the femur. These fractures often require complex surgical intervention due to strong muscle attachments in the area and generally higher risk of complication.

Treating hip fractures often requires a multifaceted approach. Hip surgery is frequently necessary to stabilize the fracture and prevent complications. The fracture’s location and pattern determine the best treatment strategy. Palliative procedures may also be considered to reduce pain for patients and focus on symptom management.

Orthopedic surgeons may use screws, plates, or opt for partial or total hip replacement depending on the fracture’s severity. Early surgical intervention, including hip fracture surgery, improves outcomes and reduces long-term complications. The goal is to restore mobility and function while minimizing pain and discomfort.

Surgical intervention is the preferred treatment for most hip fractures, with internal fixation being the most common approach. This technique uses specialized screws, plates, or rods to stabilize the fractured bone fragments and promote proper healing. For some patients, partial or total hip replacement may be recommended.

The choice of surgical technique depends on factors like the patient’s overall health and the fracture’s characteristics. Orthopedic surgeons tailor the surgical plan to each individual case to restore function while minimizing complications.

Non-surgical treatments are considered when the fracture is stable and the patient can tolerate weight-bearing with minimal pain. Protected weight-bearing, which involves the use of an assistive device like a walker, reduces stress on the affected limb to promote healing. This approach is often suitable for individuals who may not be ideal candidates for surgery due to personal health conditions.

Rehabilitation after a non-surgical approach typically includes physical therapy to strengthen muscles around the hip and improve mobility. The goal is to enhance recovery and prevent further injury, ensuring patients regain their independence and quality of life after hip surgery.

Effective recovery after hip fracture surgery requires an approach addressing both physical rehabilitation and medical management. For older adults in particular, pain control strategies including regional anesthesia and early geriatric consultation can reduce the risk of delirium post-surgery. Patients also receive preventative measures against venous thromboembolism, the formation of blood clots in the veins, when appropriate. 

Rehabilitation focuses on exercises to improve range of motion and strength, with physiotherapists playing a vital role in recovery. Regular intensive physiotherapy encourages rapid mobility progression post-surgery. The program is tailored to each patient’s surgical procedure and pre-fracture status, with the goal of restoring independence in daily activities.

Hip fractures can lead to several complications, making effective treatment and postoperative care essential. Possible complications include blood clots, delirium, and avascular necrosis (loss of bone tissue due to lack of blood supply). Pulmonary embolism, a potentially life-threatening condition, can arise from blood clots following a hip fracture.

Delirium and cognitive decline are significant concerns in older adults after a hip fracture. These complications underscore the importance of monitoring and early intervention.

Preventing hip fractures is especially important for older individuals and those with the aforementioned risk factors such as osteoporosis. Effective strategies address both bone strength and fall risk reduction. Recommended strategies include:

• Preventing falls by ensuring a safe living environment.
• Managing osteoporosis through medication and dietary changes.
• Regularly participating in weight-bearing and resistance training exercises to maintain or improve bone mineral density.

Fall prevention measures reduce the incidence of hip fractures in older adults. Simple home modifications like removing tripping hazards and installing grab bars can make a difference. Regular weight-bearing exercise and balance training improves stability.

Secondary fracture prevention is also important for individuals who have already experienced a fracture. Patients may be encouraged to take medications like bisphosphonates, which reduce fracture risk by slowing bone loss.

Optimal hip fracture treatment requires coordinated teamwork among healthcare professionals. Orthopedic surgeons, physical therapists, and other specialists collaborate to develop personalized treatment plans. A culture of shared responsibility among healthcare professionals significantly improves the quality of care.

Regular team meetings ensure all providers share the same treatment goals and progress updates. By combining expertise across specialties, patients receive comprehensive care addressing all aspects of their recovery.

Hip fractures are serious injuries with significant impacts on mobility and quality of life. Understanding the different types, causes, risk factors, symptoms, and treatment options can help guide prevention and treatment decisions. Early diagnosis through physical examination and imaging techniques, followed by prompt intervention and rehabilitation, can significantly improve recovery outcomes. Preventive strategies, including fall prevention and osteoporosis management, are helpful in reducing the incidence of hip fractures.

Through coordinated care and patient education, individuals can effectively manage hip fractures and work toward a successful recovery.

The three primary types are femoral neck fractures (just below the ball joint), intertrochanteric fractures (between the bony prominences of the femur), and subtrochanteric fractures (in the upper shaft region). Each fracture requires treatment approaches tailored to its location and characteristics.

The most telling signs include immediate, severe pain in the groin or hip, inability to put weight on the leg, and the affected leg appearing shorter or turned outward. If you or someone you know is experiencing these symptoms, seek medical attention immediately – delaying care can increase complication risks.

Hip fractures are diagnosed through a physical examination by an experienced orthopedic surgeon and imaging studies, including X-rays and possibly MRIs.

For hip fractures, the most effective treatment options typically involve surgical interventions like internal fixation or hip replacement. Surgical approaches are followed by a postoperative care and rehabilitation plan. Depending on individual patient needs, non-surgical approaches such as protected weight-bearing and physical therapy may be considered.

Effective hip fracture prevention combines multiple strategies: fall prevention through home safety modifications and balance training, proper osteoporosis management, regular weight-bearing exercise, and nutrition optimized for bone health.