Hip Fracture

A hip fracture is a break in the
thighbone (femur) of your hip joint.

Joints are areas where 2 or more
bones meet. Your hip joint is a “ball and socket” joint, where your thighbone meets your
pelvic bone. The ball part of your hip joint is the head of the thighbone. The socket is
a cup-like structure in your pelvic bone. This is called the acetabulum. Hip fracture is
a serious injury and needs immediate medical attention.

Most hip fractures happen to people
older than age 60. The incidence of hip fractures increases with age, doubling for each
decade after age 50. Caucasians and Asians are more likely to be affected than others.
This is primarily because of a higher rate of osteoporosis. Osteoporosis (loss of bone
tissue) is a disease that weakens bones.

Women are more prone to
osteoporosis than men; therefore, hip fracture is more common among women. More than
1.5 million Americans have fractures each year because of osteoporosis.

Either a single break or multiple breaks can happen in a bone. A hip fracture is classified by the specific area of the break and the type of break(s) in your bone.

The most common types of hip fractures are:

  • Femoral neck fracture. A femoral neck
    fracture happens 1 to 2 inches from your hip joint. This type of fracture is common
    among older adults and can be related to osteoporosis. This type of fracture may
    cause a complication, because the break usually cuts off the blood supply to the head
    of the thighbone, which forms the hip joint.  


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  • Intertrochanteric hip fracture. An intertrochanteric hip fracture happens 3 to 4 inches from your hip joint. This type of fracture does not usually interrupt the blood supply to your bone and may be easier to repair. 


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Most hip fractures fall into these
2 categories in relatively equal numbers. Another type of fracture, called a stress
fracture of the hip, may be harder to diagnose. This is a hairline crack in the
thighbone that may not involve your whole bone. Overuse and repetitive motion can cause
a stress fracture. The symptoms of this injury may mimic those of tendonitis or muscle
strain.

A fall is the most common reason
for a hip fracture among the elderly. A few people may have a hip fracture happen
spontaneously. If you are younger, a hip fracture is generally the result of a car
accident, a fall from a great height, or severe trauma.

Hip fracture is more common in older people. This is because bones become thinner and weaker from calcium loss as a person ages. This is generally due to osteoporosis.

Bones affected by osteoporosis are more likely to break if you fall. Most hip fractures that older people get happen as a result of falling while walking on a level surface, often at home.

If you are woman, you lose 30% to
50% of your bone density as you age. The loss of bone speeds up dramatically after
menopause, because you make less estrogen. Estrogen contributes to maintaining bone
density and strength.

You are at risk for a hip fracture
if you have osteoporosis. Older age also puts you at more risk. Other things that may
raise your risk include:

  • Excessive alcohol consumption
  • Lack of physical activity
  • Low body weight
  • Poor nutrition including a diet low on calcium and vitamin
    D
  • Gender
  • Tall stature
  • Vision problems
  • Thinking problems such as
    dementia
  • Physical problems
  • Medicines that cause bone loss
  • Cigarette smoking
  • Living in an assisted-care
    facility
  • Increased risk for falls, related to
    conditions such as weakness, disability, or unsteady gait

There may be other risks, depending
on your specific health condition. Discuss any concerns with your healthcare
provider.

The following are the most common
symptoms of a hip fracture:

  • Hip pain or pain that you can feel in
    your knee
  • Low back pain
  • Inability to stand or walk
  • Bruising and swelling
  • Foot turned out at an odd angle, making your leg look shorter

The symptoms of hip fracture may
seem like other medical conditions. Always see your healthcare provider for a
diagnosis.

In addition to a complete medical history and physical exam, diagnostic procedures for hip fracture may include the following:

  • X-ray. Invisible electromagnetic energy beams produce images of internal tissues, bones, and organs onto film.
  • MRI. A combination of large magnets,
    radiofrequencies, and a computer produce detailed images of organs and structures
    within your body.
  • CT scan. This is an imaging test that
    uses X-rays and a computer to make detailed images of the body. A CT scan shows
    details of the bones, muscles, fat, and organs. CT scans are more detailed than
    standard X-rays.


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A fracture of your hip is generally
treated with surgery. Your surgeon may use metal devices to strengthen and stabilize
your joint. In some cases, he or she may do a partial or total hip replacement. The type
of surgical repair will depend on the type of hip fracture. Your surgeon will determine
the best procedure for you, based on your situation. The goal of treatment is to provide
relief from pain and enable you to resume your normal activity level. Hip surgery
usually requires an in-hospital stay. While in the hospital, you start doing physical
therapy exercises to regain strength and range of motion in your hip. Physical therapy
will continue at home or on admission to a rehabilitation facility.

Serious complications can result from a hip fracture. Blood clots can happen in the veins, usually in your legs. If a clot breaks off, it can travel to a blood vessel in your lung. This blockage, called a pulmonary embolism, can be fatal.

Other complications can include:

  • Pneumonia
  • Muscle atrophy (wasting of muscle tissue)
  • Postoperative infection
  • Nonunion or improper union of your bone
  • Mental deterioration after surgery in
    older patients
  • Bedsores from lying in the same position with minimal movement

With some fractures, blood can’t
circulate properly to the head of the thigh bone. This results in a loss of blood supply
to this area. This is called femoral vascular necrosis, or avascular necrosis. This
complication may happen, depending on the type of fracture and the anatomy of your blood
supply to the head of the thigh bone. This is more common with femoral neck
fractures.

Most people spend from 1 to 2 weeks in the hospital after a hip fracture. The recovery period may be lengthy, and may include admission to a rehabilitation facility. If you were previously able to live independently, you will generally need help from home caregivers or family, or need the services of a long-term care facility. Hip fractures can result in a loss of independence, reduced quality of life, and depression. This is especially true for older people.

Preventive measures include taking enough calcium every day.

If you are a woman at menopause, you should consider having a bone density test. This measures your bone mineral content and the thickness of your bone. This measurement can indicate decreased bone mass. This is a condition in which your bones are more brittle and more prone to break or fracture easily. A bone density test is used primarily to diagnose osteoporosis and to determine fracture risk.

Women make less estrogen when
menopause starts. Most people do not know they have osteoporosis until they have a
fracture.

Another way to help prevent hip
fracture is to do regular weight-bearing exercise, such as walking, jogging, or hiking.
Exercise programs such as Tai Chi help promote strength and balance.

Other preventive measures may include:

  • Taking medicines as prescribed by
    your healthcare provider to prevent bone loss
  • Eating a diet rich in vitamin D and
    calcium, including milk, cottage cheese, yogurt, sardines, and broccoli
  • Stopping smoking
  • Not drinking too much alcohol
  • Keeping objects off the stairs and
    floors, such as electrical cords, to prevent falls
  • Using slip-resistant rugs next to the
    bathtub, and installing grab bars in the tub
  • Positioning night lights from the
    bedroom to the bathroom
  • Using rug pads or nonskid backing to
    keep rugs in place
  • Not using unsteady furniture or step
    ladders to stand on
  • Visiting an ophthalmologist every year
    to have vision checked annually and vision loss treated
  • Most hip fractures happen to people older than 60.
  • A fall is the most common reason for a
    hip fracture among elderly adults.
  • Hip fracture is more common among
    women.
  • Osteoporosis and advancing age are the
    major risk factors.
  • A fracture of the hip is generally
    treated with surgery.
  • Serious complications can result from
    a hip fracture.
  • Women at menopause should consider
    having a bone density test.
  • Regular weight-bearing exercise helps
    to prevent a hip fracture.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.