Hip Fractures

Causes of Hip Fractures

In older people, a hip fracture can occur from something as simple as a trip in the home or an awkward twisting movement. In fact, sometimes bones become so weakened by osteoporosis that a break can happen just from walking or standing. Other factors such as failing eyesight and balance problems increase the chance of older people sustaining a hip fracture. As orthopaedic surgeons, we frequently treat younger patients with hip fractures that are the result of sporting injuries. These may be the result of a direct impact, collision or fall. Stress fractures are due to repeated impact to the neck of the femur and are common among certain types of athletes, such as long-distance runners. Some kinds of medication also increase the likelihood of hip fractures.

Symptoms of Hip Fractures

While some fractures are very obvious – for example, open fractures where the bone is sticking out through an open wound in the skin – other types of fractures can be harder to distinguish from soft tissue damage (strains, sprains or tears). The signs that you may have fractured your hip include:

• Severe pain and swelling in your hip, groin or and upper thigh.
• Being unable to stand or put weight on the injured hip.
• Being unable to move the upper part of your leg or knee.
• Bleeding, bruising or obvious deformity.

Diagnosis of Hip Fractures

If you suspect a fracture, you should seek urgent treatment. If a physical examination indicates to your doctor that you have fractured your hip, you will be sent for an X-ray to confirm the diagnosis and determine the location and extent of the fracture. If you have a hairline fracture, this may not show up clearly on an X-ray and you may be given an MRI scan as well. Most hip fractures either occur at the top of the femur or in the intertrochanteric region where the upper part of the femur juts out.

Treatment of Hip Fractures

Most hip fractures will need to be treated surgically within one to two days of the injury to lessen the risk of developing complications. Prior to surgery you will need to have tests to ensure you are medically fit and to optimise you to make the best possible recovery. For example, if you are taking blood thinners you may have to wait for your clotting rate to increase before you can have surgery.

Treatment for a hip fracture will be determined by the type, severity and location of the fracture. If you have fractured the femoral neck (head of your thighbone), surgical pins or screws may be inserted to hold the ball of the femur in place until the fracture has healed. In some younger, healthy patients, it may be possible to treat a non-displaced femoral neck fracture without surgery but it will need to be monitored carefully as the fracture heals.

In the case of a displaced femoral neck fracture, there can be problems with healing as the blood supply comes through an area called the posterior capsule which may also have been injured. Without a sufficient blood supply, there is a risk of developing avascular necrosis in the head of the femur, which is a serious condition that can cause the femoral head to collapse. For this reason, most displaced femoral neck fractures are treated with a total hip replacement.

Intertrochanteric fractures occur below the femoral neck and there might be multiple fragments of bone. In this case, the surgeon will use a compression hip screw to fix the outer side of the bone in place and a side plate in the femoral head. The idea is to increase stability and promote healing in the area.

Less common types of hip fracture include greater trochanter fractures which normally heal without surgery, subtrochanteric fractures, which affect the upper part of the femur shaft, and femoral head fractures which are normally caused by a high speed collision.

Your orthopaedic surgeon will discuss the possible treatment options with you based on the type of injury you have sustained and your overall state of health. After surgery, exercises from a physiotherapist can help you to rebuild strength and flexibility in your hip and leg

Outcomes of hip fracture treatment

Outcomes depend on the age and general state of health of the patient, the extent of the fracture and the type of treatment given. Older patients may need support to rehabilitate after a hip fracture to help them to walk independently again and carry out everyday activities. Physiotherapy can help to build strength and mobility in the affected hip. If you have had internal fixation surgery you may not be able to put weight on the affected hip for several weeks, however, in the case of hip replacement you will normally be able to put weight on your new hip immediately.