Hip Fractures

A hip fracture is a crack or break in the femur (thighbone) close to the hip joint.  Hip fractures are typically the result of a fall or injury to the hip.  The risk of a fracture increases with age due to the weakening of the bones (osteoporosis), increased medications, poor vision or other medical conditions such as cancer.

A hip fracture will usually require surgical treatment and physiotherapy.  Making an effort to maintain and improve bone density and avoid falls will help prevent a hip fracture.

The hip is a ball and socket joint.  The ball (the femoral head) is located at the top of the femur.  The socket (the acetabulum), makes up part of the large pelvis. The ball rotates in the socket, allowing the leg to move backward, forward and sideways.  Smooth cartilage surrounds the ball and socket allowing them to glide freely together and protect the joint.

Causes of Hip Fractures

Hip fractures can occur in people of all ages following a severe impact such as a car crash.  In older adults, especially people over the age of 80, a hip fracture is often a result from a fall.  In people that have weak bones, a hip fracture can happen simply by standing on the leg and twisting.

Hip fractures are more common in women as they are more likely to develop osteoporosis, a condition that weakens the bones.  Risk factors that increase your risk of a hip fracture include:

Age
Over time, bone density and muscle mass decrease, causing reduced support.  Older people may experience issues with their vision or balance, which also increases their risk of falling.

Gender
Hip fractures are more common in women than men as they lose bone density quicker than men, due to menopause that accelerates bone loss.

Osteoporosis
A condition that causes bones to weaken.

Chronic medical conditions
Endocrine disorders such as an overactive thyroid can result in fragile bones.  Medical conditions that affect the nervous system and brain such as dementia and Parkinson’s disease also increase the risk of falling.

Medication
Medications such as cortisone can weaken the bone if you continue to take them long-term.  Certain medications or combinations of drugs can also cause dizziness, making you more prone to falling.

Nutrition
A lack of vitamin D and calcium in your diet when you’re young increases your risk of fracture in later life as it lowers your peak bone mass.  It is also important, as you get older to get enough vitamin D and calcium to help maintain bones.

Exercise
Not getting enough weight bearing exercise such as walking can result in weakened bones and muscles, making you more prone to falling.  As you get older, try to maintain a healthy weight.  Being underweight increases the risk of bone loss.

Symptoms of a Hip Fracture

Following a fracture, you will probably feel a lot of pain in your hip or groin.  You may not be able to walk and your skin around the injury may become inflamed and bruised.  Common signs and symptoms of a hip fracture include:

• Pain in your hip and groin
• Inability to lift, rotate or move your leg
• Inability to stand or put weight on your leg of the affected hip
• Bruising and swelling in and around your hip
• The affected side leg may appear shorter
• The leg on the side of the injured hip turning outwards

A hip fracture does not always cause bruising or prevent you from walking or standing.

Diagnosis of a Hip Fracture

In many cases, your doctor will be able to determine whether you have a hip fracture based on your symptoms and the shape or position of your hip and leg.  An X-ray is a diagnostic tool that will usually be able to confirm that you have a fracture and determine the location.  If the X-ray does not highlight a fracture but you are still experiencing hip pain, your doctor may suggest an MRI scan or bone scan to look for a hairline fracture.

Most hip fractures occur in one of two locations on the long bone that extends from your pelvis to your knee (femur):

The Femoral Neck
Located in the upper area of your femur (thighbone), just below the ball part (femoral head) of the ball-and-socket joint.

The Intertrochanteric Region
This area is a little lower down from the hip joint, in the section of your upper femur that projects outward.

Treatment of a Hip Fracture

Surgery is generally the only option to treat a hip fracture.  The type of surgery you have typically depends on how severe the fracture is, whether the broken bones are aligned and your age and general health. Surgical options include:

Internal repair using screws
Metal screws are used to hold the bones together while the fracture heals.  In some cases, screws are attached to a metal plate that runs down the femur to provide extra support.

Total hip replacement
The upper femur and the socket in the pelvic bone are substituted with artificial parts (prosthesis).

Partial hip replacement
If the ends of the fractured bone are damaged, your consultant might remove the head and neck of the femur and fix a metal replacement.  Partial hip replacement may be suggested for people who have other health conditions or who no longer live independently.

Post-Operative Recovery

The aim for surgery to treat a fracture is to speed up recovery and regain mobility.

You will likely be asked to try to move on the first day following surgery.  A physiotherapist will start by focusing on your range of motion and exercises to recover strength.

You will require additional care to carry out jobs such as bathing, dressing and cooking at home following surgery.  It is important to arrange this before surgery.  Speak with your consultant if you do not have additional support at home following the surgery.

How long you will need to remain in hospital will depend on the surgery you had, your condition and your mobility.

Outlook

Early diagnosis is a key step in treating fractures. I f you feel like you are experiencing pain or showing symptoms, make an appointment with your doctor.

Although it is impossible to entirely prevent fractures, there are steps you can take to help avoid them.  Maintain a healthy lifestyle, avoid drinking and smoking and wear protective gear when playing sport.

Need Help?

If you are experiencing pain in your hip which you think could be caused by a fracture, you can be seen by a Consultant Orthopaedic  Hip Surgeon at One Ashford Hospital, usually within 48 hours.  One Ashford Hospital is well placed to treat patients with hip injuries from Ashford, Maidstone, Canterbury, Folkestone, Dover and all surrounding villages.  To book an appointment, call the hospital direct on 01233 364 022 or email here.