Hip Fracture

Overview

Definition

A hip fracture is a break in the thigh bone. The break happens just below the hip joint.

The thigh bone has a ball at the top of the bone. The hip joint includes this ball and a socket in the pelvis. Most hip fractures occur in the 1 to 2 inches just below the ball portion of the hip.

Hip Fracture
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Causes

A hip fracture is caused by trauma to the bone.

Fractures in young people with healthy bones are caused by major trauma. The most common is a car accident.

Older adults or people with conditions that weaken bones may be caused by minor trauma, such as a fall.

Risk Factors

Factors that increase the risk of fracture in people with healthy bones include:

  • Major trauma, such as motor vehicle accidents, a fall from a great height, and other types of major trauma
  • Increased age

Women are more likely than men to fracture their hips, especially after menopause. It is more common in older adults. Other factors that increase the risk of hip fractures include:

  • Previous hip fracture or history of falling
  • Family history of fractures later in life
  • Small-boned, slender body—low body weight

Factors that can weaken bone and increase the risk of fractures include:

  • Osteoporosis —a bone-thinning condition that weakens all bones
  • Poor nutrition
  • Deficient intake or absorption of calcium and vitamin D
  • Physical inactivity
  • Smoking
  • Kidney disease
  • Cortisone or other steroids
  • Thyroid disorder
  • Low testosterone in men
  • Bone conditions such as osteomalacia—rare
  • Bone tumors—rare

Factors that increase the risk of falls that can lead to fractures include:

  • Weakness
  • Poor balance and coordination
  • Excessive alcohol use
  • Irregular heart beat or low blood pressure
  • Chronic disease or fragile health
  • Diabetes
  • Arthritis
  • Parkinson disease
  • History of stroke
  • Problems with vision
  • Heart failure
  • Mental impairments including Alzheimer disease
  • Certain medications which cause lightheadedness, drowsiness, or weakness

SymptomsandDiagnosis

Symptoms

A hip fracture may cause:

  • Pain in the hip
  • Difficulty or inability to stand, walk, or move the hip
  • Abnormal appearance of the broken leg:
    • Looks shorter
    • Turns outward

Diagnosis

You will be asked about your symptoms. You may be asked about any recent falls or injury details. A physical exam will be done.

Images may be taken of your bones. This can be done with:

  • X-ray
  • MRI scan
  • CT scan
  • Bone scan

Treatments

Treatment

Talk with your doctor about the best treatment plan for you. Options include:

Surgery

Surgery is needed for most hip fractures. This will make sure the hip heals properly. Surgery will also allow you to move about as you recover.

The type of surgery will depend on location of break, how severe it is, and overall bone health. Surgical options include:

  • Plates and screws will be used over the area. They will help to align the bones and support them while they heal.
  • Hip replacement may be needed. Damaged areas are removed. A metal devices is inserted in its place. This options is reserved for those with severe bone injury. It is more common in older adults.

Your doctor may recommend devices to help you start walking. This may include a wheelchair, cane, or walker.

Surgery is not a good option for some people. Those with a small fractures or poor overall health may need to let the bone heal on its own. The fracture will be monitored with imaging tests. This will make sure it is healing properly. Traction may also be used. It can hold the leg in place while the bone heals.

Physical Therapy

A physical therapist will assess the hip fracture. An exercise program can strengthen the muscles help recovery. They may also help reduce the risk of future falls.

Prevention

Major trauma is often caused by accidents and hard to avoid.

Work with your doctor if you have a condition that can weaken the bone. Medicine, changes to the diet, and weight bearing activities may help slow bone loss.

To reduce the risk of falls:

  • Ask your doctor if any of your medicine may cause lightheadedness, drowsiness, or confusion.
  • Get your eyes checked regularly.
  • Clean spills and slippery areas right away.
  • Remove tripping hazards such as loose cords, rugs, and clutter.
  • Use non-slip mats in the bathtub and shower.
  • Install grab bars next to the toilet and in the shower or tub.
  • Put in handrails on both sides of stairways.
  • Walk only in well-lit rooms, stairs, and halls.
  • Keep flashlights on hand in case of a power outage.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

RESOURCES

Family Doctor—American Academy of Family Physicians http://familydoctor.org 

OrthoInfo—American Academy of Orthopaedic Surgeons http://orthoinfo.org 

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org 

Canadian Orthopaedic Foundation http://www.canorth.org 

References

Hip fracture. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T116789/Hip-fracture . Updated January 26, 2018. Accessed March 5, 2018.

Hip fracture prevention. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00309. Updated January 2013. Accessed March 5, 2018.

Ly, Thuan V and Swiontkowski, Marc F Management of femoral neck fractures in young adults. Indian J Orthop. 2008 Jan-Mar; 42(1): 3–12.

van Diepen S, Majumdar SR, Bakal JA, McAlister FA, Ezekowitz JA. Heart failure is a risk factor for orthopedic fracture: a population-based analysis of 16,294 patients. Circulation. 2008;118(19):1946-52.

11/6/2009 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T116789/Hip-fracture : Sennerby U, Melhus H, Gedeborg R, et al. Cardiovascular diseases and risk of hip fracture. JAMA. 2009;302(15):1666-1673.

1/4/2011 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T116789/Hip-fracture : Lee JS, Buzková P, Fink HA, et al. Subclinical thyroid dysfunction and incident hip fracture in older adults. Arch Intern Med. 2010;170(21):1876-1883.

4/24/2014 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T116789/Hip-fracture : Ward RJ, Weissman BN, et al. ACR Appropriateness Criteria for acute hip pain: suspected fracture. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/AcuteHipPainSuspectedFracture.pdf. Published 2013. Accessed February 11, 2016.