Hip (femoral) Fracture

Femoral fracture Hip fracture

A hip fracture is a break in the upper part of the thigh-bone (femur) that forms part of the hip joint. It can occur in the femoral head, neck, or trochanteric region (the bony protrusion on the side of the femur). Hip fractures are most commonly caused by falls, particularly in older adults with weakened bones due to conditions such as osteoporosis. Other causes of hip fractures can include trauma, such as a car accident, or repetitive stress on the hip joint. Hip fractures are a serious injury that can lead to significant pain, disability, and loss of mobility. They often require prompt medical attention and treatment, which can include surgery and rehabilitation.

Types of Hip Fracture

There are two main types of hip fractures:

  • Femoral neck fractures: This type of hip fracture occurs at the junction of the femoral neck and the head of the femur. It is most common in older adults, especially women with osteoporosis. This type of fracture can disrupt blood flow to the femoral head and may require surgery to repair.
  • Intertrochanteric fractures: This type of hip fracture occurs in the region between the femoral neck and the lesser trochanter. It is more common in older adults and is usually caused by a fall or other trauma. This type of fracture is often treated with surgery to stabilize the bone and restore mobility.
  • Fracture of the Greater Trochanter: Isolated fractures of the greater trochanter usually come from a low-energy household fall. While they are often painful, they usually heal without surgery. These fractures are stable and can be treated with protected weightbearing with either crutches or a walker.
  • Subtrochanteric Fracture: Subtrochanteric fractures involve the upper part of the shaft of the femur, just below the hip joint. They are treated surgically with an intramedullary nail into the shaft of the femur and a screw placed through the nail into the femoral head.
  • Femoral Head Fracture: Femoral head fractures are rare; they account for less than 1% of all hip fractures. They usually result from a high-velocity event. Sometimes there may be an associated fracture of the hip joint socket.

If the fracture is not displaced, it may be treated nonsurgically with limited weightbearing. If there is a small displaced fragment that does not involve a large part of the joint surface, then the fragment may be simply removed.

Symptoms of Hip Fracture

The symptoms of a hip fracture may include:

  • Severe pain in the hip or groin area
  • Inability to bear weight on the affected leg
  • Swelling and bruising around the hip
  • Stiffness and limited range of motion in the hip
  • Shortening of the affected leg
  • Turning of the affected leg outward
  • A popping or cracking sound at the time of injury
  • Numbness or tingling in the leg or foot

If you suspect that you or someone you know has a hip fracture, it is important to seek medical attention immediately

Causes of Hip Fracture

There are several causes of hip fractures, including:

  • Falls: This is the most common cause of hip fractures, especially in older adults. Falls may occur due to factors such as balance problems, vision problems, medications that affect coordination, and hazards in the environment.
  • Osteoporosis: This is a condition that causes bones to become weak and brittle, making them more likely to fracture, even with minor trauma.
  • Trauma: Hip fractures can also occur due to high-impact trauma, such as a car accident or a sports injury.
  • Cancer: Certain types of cancer, such as bone cancer, can weaken bones and increase the risk of fractures.
  • Other medical conditions: Certain medical conditions, such as hyperparathyroidism, Cushing’s syndrome, and some autoimmune disorders, can weaken bones and increase the risk of fractures.
  • Medications: Long-term use of certain medications, such as corticosteroids, can weaken bones and increase the risk of fractures.
  • Nutritional deficiencies: A lack of vitamin D and calcium can weaken bones and increase the risk of fractures.

It is important to identify and address any underlying causes of hip fractures to prevent future fractures from occurring.

Diagnostics of Hip Fracture

Hip fractures are typically diagnosed using a combination of physical examination, medical history, and imaging tests. A doctor will perform a physical exam to look for signs of a hip fracture, such as pain, tenderness, swelling, bruising, or deformity in the hip or upper thigh. Imaging tests such as X-rays, CT scans, or MRI scans are commonly used to confirm the diagnosis and determine the extent of the fracture. In some cases, a bone scan or ultrasound may be used to help detect fractures that do not show up on X-rays.  It is important to diagnose a hip fracture as soon as possible, as early treatment can help to prevent complications and improve the chances of a successful recovery.

Complications of Disease

If left untreated, hip fractures can lead to a number of serious complications, including:

  • Increased pain and immobility: Hip fractures can cause significant pain and make it difficult or impossible to move around. This can lead to further muscle weakness, decreased mobility, and a higher risk of falls and fractures.
  • Blood clots: Reduced mobility and bed rest after a hip fracture can increase the risk of blood clots in the legs, which can break off and travel to the lungs, causing a life-threatening condition called pulmonary embolism.
  • Pneumonia: Bed rest and reduced mobility after a hip fracture can also increase the risk of pneumonia, a lung infection that can be serious, especially in older adults.
  • Pressure sores: Being immobile for extended periods of time can cause pressure sores, also known as bedsores, which can lead to infections and other complications.
  • Increased risk of death: Hip fractures can be especially serious in older adults, and studies have shown that they are associated with an increased risk of death, especially in the first year after the fracture.

Early treatment, including surgery if necessary, can help to prevent these complications and improve the chances of a successful recovery.

Treatment of Hip Fracture

Nonsurgical treatments for a hip fracture typically involve the use of mobility aids such as crutches or a walker, as well as physical therapy to help regain strength and mobility in the affected hip joint. Pain medications and medications to prevent blood clots may also be prescribed.

Surgical treatment options for a hip fracture depend on the location and severity of the fracture, as well as the patient’s age and overall health. The most common surgical options include:

  • Internal fixation: This involves the use of screws, plates, or nails to hold the fractured bones in place while they heal.
  • Partial or total hip replacement: This may be recommended for older patients with a more severe fracture that affects the hip joint, or for those with pre-existing hip conditions such as osteoarthritis.
  • Hemiarthroplasty: This involves replacing only the head of the femur with an artificial implant, while leaving the hip socket intact.

The specific surgical approach will depend on the patient’s individual circumstances and the recommendation of their healthcare provider.