Hip fracture
What is a hip fracture?
One of the most serious fall injuries is a broken hip. A hip fracture is a break high up in the thighbone (femur) near the hip joint. It is a serious and painful condition that requires immediate medical attention.
It is hard to recover from a hip fracture and afterward many people are not able to live on their own. As the U.S. population gets older, the number of hip fractures is likely to go up.
- Each year over 300,000 older people--those 65 and older--are hospitalized for hip fractures.
- More than 95% of hip fractures are caused by falling, usually by falling sideways.
- Women experience three-quarters of all hip fractures.
- Women fall more often than men.
- Women more often have osteoporosis, a disease that weakens bones and makes them more likely to break.
- The chances of breaking your hip go up as you get older.
Hip fractures can lead to frailty, loss of mobility and independence and an increased risk of death. However, there are many things that can be done to prevent falls and reduce your risk of having a hip fracture.
Hip joint
The hip joint is made up of:
- A cup-shaped hip socket (acetabulum) of the pelvis, and;
- The ball-shaped head of the thighbone (femur).
The head of the femur sits inside the acetabulum and is able to rotate freely, which gives the hip its wide range of movement. The joint is surrounded by strong ligaments that helps provide support.
Various bones of the hip and locations of possible fractures.
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Pelvis
The bony structure in the lower part of the body trunk that connects the base of the spine to the legs. The pelvis protects important organs, such as the bladder and bowel (and in women, the uterus), and anchors thigh and abdominal muscles.
Risk factors
A hip fracture occurs when there is sufficient force through the hip joint, which is more than what the bones can withstand. The bone may develop a crack or break completely, which usually occurs at its weakest point. The amount of force needed to fracture bones usually reduces with advancing age, as bones naturally lose their strength. Underlying bone conditions such as osteoporosis can further increase the risk for hip fractures.
Falls from a standing position and mild trauma are common causes of hip fractures in the elderly population. In younger people, most hip fractures are due to high-impact injuries, such as from car collisions or falling from a height.
Factors that can increase the risk of falling include:
- Loss of muscle associated with ageing;
- Problems with walking and mobility;
- Balance problems and poor reaction times;
- Some medications, particularly those used to treat high blood pressure, depression, anxiety and problems with sleeping. This is particularly the case when people are taking multiple medications;
- Low blood pressure, which can lead to dizziness or fainting;
- Vision loss or impairment, and;
- Dementia and cognitive (thinking) problems.
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Dementia
A collection of symptoms caused by permanent disorders of the brain. People with dementia lose their ability to think and reason clearly, which has an impact on their daily functioning.
Types of hip fractures
A hip fracture can occur at:
- The neck of the femur. This is sometimes called an intracapsular fracture, because it occurs inside the hip joint capsule;
- Between the trochanters (the bony lumps on the femur where muscles attach);
- Below the trochanters, or;
- Fractures of the hip socket (the acetabulum) can also occur. These are less common and tend to be caused by high-impact accidents or in those with bones weakened by osteoporosis.
In more severe injuries, there may be fractures at more than one location in the hip. The position of a fracture may influence what kind of treatment is required.
Signs and symptoms
Symptoms of a hip fracture can include:
- Severe pain around the injured hip and groin;
- Being unable to move or lift the injured leg;
- Bruising and swelling around the hip;
- The injured leg may appear shorter, and;
- The injured leg may tend to turn outwards.
Most people with a fractured hip will be unable to stand or put weight on the leg on the affected side. There may also be other associated injuries that need investigation and treatment.
A fractured hip is a serious condition that requires prompt medical attention.
Methods for diagnosis
Most individuals suspected of having a hip fracture are taken to an emergency department for investigations and treatment. Your doctor will likely ask how the injury happened, as well as perform a thorough physical examination to help diagnose a hip fracture, assess for other injuries and exclude an underlying medical condition for the fall, such as a heart attack or stroke.
Imaging tests are used to confirm the hip fracture, its type and the extent of the fracture. The most common tests are X-rays and computerized tomography (CT) scan.
You are likely to also have the following:
- Pain relief to make you more comfortable;
- Intravenous fluids to prevent dehydration. You may be asked to fast, if you need surgery;
- Rest in bed, and
- A urinary catheter to help pass urine, which can otherwise be difficult if you are bedbound.
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Catheter
A thin, flexible tube inserted through a narrow opening into a body cavity for removing fluid.
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Computerized tomography
A scan that uses X-rays to create a 3D image of the body. This can detect abnormalities more effectively than a simple X-ray can.
Types of treatment
The definitive treatment for a hip fracture is surgery. This is usually done soon after the injury (within a day or so) to help improve healing. There are numerous types of surgery that can be performed, which depends on:
- The position of the fracture;
- The condition of the hip joint prior to the injury and whether it is affected by arthritis, and;
- Your age, level of mobility and whether you have any cognitive problems such as dementia.
Types of surgical techniques include:
- Internal fixation - in this procedure, pins, screws, rods and/or plates are used to hold the fracture together to allow it to heal;
- Hemiarthroplasty - this procedure is also called a partial hip replacement and involves replacing the head of the femur with a prosthesis (an artificial piece), and;
- Complete hip replacement - this procedure, commonly called a hip replacement, involves replacing both the head of the femur and the socket of the hip joint (acetabulum).
A specialized surgeon, called an orthopedic surgeon, performs the procedure and can discuss which option is most suitable for a particular individual. Surgery for a hip fracture usually takes around two hours. It can be performed under general anesthetic or under regional anesthetic, in which only the lower part of the body is numbed. Regional anesthesia may be used when administration of a general anesthetic poses a significant risk, particularly in those who are frail and have multiple medical conditions.
What happens after the surgery?
After surgery, you will usually be encouraged to get out of bed and become mobile again. Staff such as physiotherapists and nurses will help you with this to make sure that you move safely and do not fall.
A rehabilitation program can help you recover from the hip injury and become more independent with tasks involved in looking after yourself. Depending on your health, you may do some of your rehabilitation in hospital, at a rehabilitation unit or at home after you are discharged from hospital. Full recovery from a hip fracture can take a couple of months to a year.
Your rehabilitation program can be tailored to your particular needs and circumstances. It may involve a range of health professionals such as doctors, physiotherapists, occupational therapists, nurses and social workers.
Rehabilitation will often include doing various kinds of exercise, depending on your fitness and health. It may also include an assessment of your home, to see if things can be changed to reduce your risk of falling again.
If you have osteoporosis, treating this condition may help to prevent more fractures happening in the future. Your doctor can advise you on the most appropriate treatment of the osteoporosis.
A rehabilitation program, after hip replacement, assists recovery.
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Dementia
A collection of symptoms caused by permanent disorders of the brain. People with dementia lose their ability to think and reason clearly, which has an impact on their daily functioning.
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General anesthetic
An anesthetic given to a person to put them to sleep while having an operation or medical procedure. Afterwards, the person regains consciousness and usually has no memory of the procedure. A general anesthetic is given in hospital by a specialist called an anesthetist.
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Occupational therapists
A healthcare professional trained to deliver occupational therapy, which involves teaching a person self care, work and play activities to promote independence and reduce disability.
Potential complications
The potential complications of having a hip fracture and recovering from surgery include:
- Blood clots forming in the deep veins of the legs (deep vein thrombosis);
- Infections, such as pneumonia, urinary tract infections and wound infections;
- Pressure sores (sometimes called bedsores). These are ulcers that can develop because of pressure on a patch of skin when a person is unable to get out of bed or a chair, and;
- Weakness and deconditioning due to lack of muscle use.
Becoming mobile soon after surgery can help reduce the risk of these complications. Medications to prevent blood clotting and wearing pressure stockings on your legs can also help to prevent these kinds of problems.
Some people, despite rehabilitation, are unable to make a full recovery. They may not be able to return home and live independently, in which case they may need to move to residential aged care or a nursing home.
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Ulcers
An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.
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Clotting
The process by which blood changes from a liquid to a semi-solid state, usually to seal off any sites of bleeding. This is also known as coagulation.
Prognosis
Several factors, such as age and general health, can influence recovery. Participating in a rehabilitation program can greatly aid a return to physical activity.
Prevention
Ways to prevent hip fractures include:
- Preventing or treating osteoporosis, and;
- Taking steps to prevent falls from occurring.
There are many things that can be done to prevent falls. These can include:
- Exercises and training to promote better balance and mobility;
- Making sure your medication levels are appropriate for your needs, particularly if you are taking many medications;
- Having an occupational therapist assess your home and yard. Removing tripping hazards and installing balance aids, such as hand rails, where they are needed;
- Making sure your vision is as clear as possible and wearing appropriate prescription glasses, if needed, and;
- Dealing with foot problems and wearing suitable footwear.
You can talk to your doctor about reducing your risk of falling and services that may be available if you need help.
References
- Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from link here
- About Australian & New Zealand Hip Fracture Registry. Accessed November 11 2014. link here
- About Falls Risk Factors - Stay On Your Feet. Accessed August 14 2014. link here
- Acetabular Fracture -Cedars-Sinai. Accessed August 14 2014. link here
- Bone Fractures | Better Health Channel. Accessed August 14 2014. link here
- Falls and Medicines - Stay On Your Feet. Accessed August 14 2014. link here
- Hip Fracture - NHS Choices. Accessed August 14 2014. link here
- Hip Fracture Surgery: MedlinePlus Medical Encyclopedia. Accessed August 14 2014. link here
- Minimum-Standards-for-the-Management-of-Hip-Fractures.pdf. Accessed August 14 2014. link here
- Osteoporosis | Better Health Channel. Accessed August 14 2014. link here
- RACGP - Falls Prevention in Older Adults Assessment and Management. Accessed August 14 2014. link here
- The Problem of Osteoporotic Hip Fracture in Australia (full Publication) (AIHW) - DownloadAsset.aspx. Accessed August 14 2014. link here
10 Most frequently asked questions (FAQs)
A hip fracture is a break that occurs high up in the thigh bone (femur) near the hip joint. It is a serious and painful condition that requires immediate medical attention. What are the symptoms of a hip fracture? Most hip fractures happen after a fall or blow to the hip. Symptoms include severe pain around the hip and groin, bruising and swelling, not being able to stand on the injured leg or move or rotate it. The injured leg may appear shorter and tend to turn outwards. What causes a hip fracture? Most hip fractures happen after a fall or blow to the hip in people over 65 years of age, who often have more fragile bones that are more prone to fracturing. In younger people, hip fractures are usually caused by high-impact accidents, such as car collisions. Most hip fractures happen to people over 65 years of age who have had a fall or blow to the hip. Women in this age group are more likely to have a hip fracture because they are more likely to fall and more likely to have weaker bones. How is a hip fracture diagnosed? Most hip fractures are diagnosed in hospital after a fall. Imaging tests such as an X-ray or CT scan are used to confirm the position of the fracture. How is a hip fracture treated? The first step in treatment for a hip fracture is to make sure the person is in a stable medical condition and to provide pain relief. Surgery is usually recommended to repair the hip and generally takes place within a day or so of the injury. Following surgery, rehabilitation helps the person get back on their feet. Can a hip fracture be prevented? There are many things people can do to prevent hip fractures. These include taking steps to keep your bones as strong as possible (such as good diet, weight bearing exercise and treatments for osteoporosis) and preventing falls. Are there different types of a hip fracture? Hip fractures may be described as intracapsular when the fracture occurs up in the head or neck of the thigh bone (femur), inside the joint capsule; or extracapsular, when the fracture occurs lower down, on the upper part of the shaft of the femur. What is the outcome for a hip fracture? Surgery can help many people recover from a hip fracture. However, not everyone recovers fully and some people may find that they are not as mobile as they were before their injury. Is a hip fracture serious? A hip fracture is a serious injury and requires immediate medical attention. Hip fractures can lead to frailty, loss of mobility and independence and an increased risk of death.
Related topics
Perthes’ disease (also known as Legg-Calve-Perthes’ disease) occurs in children when blood supply is disrupted to the top of the thighbone (femur), leading to pain and damage in the hip joint. Avascular necrosis (osteonecrosis)
Avascular necrosis describes the death of bone tissue that occurs when the blood supply to an area of bone is cut off. It causes severe damage to the bone and is also known as ischemic bone necrosis, aseptic necrosis, bone infarction and osteonecrosis. Osteoporosis occurs when bones become brittle and are more easily fractured. It is more common in women, particularly after menopause when oestrogen levels are low, as oestrogen helps maintain bone mass. Numerous treatment options are available for osteoporosis. Age-related hearing loss, medically known as presbycusis, is the partial or complete loss of hearing that develops with age. It is a common condition, with up to one in three people over the age of 65 affected by varying degrees of hearing loss.