Hip Fracture

A hip fracture is a serious injury that involves a crack or break in the upper portion of the femur (thigh bone) close to the hip joint. The extent of fracture depends on the forces involved in the injury.

The risk of hip fracture increases with age. Elderly people are at a higher risk of hip fracture because their bones tend to become weak with age (osteoporosis).

Multiple medications, poor vision and balance problems also make older people more likely to trip and fall, which is one of the most common causes of hip fracture.

A hip fracture almost always requires surgical repair or replacement, followed by months of physical therapy. The type of surgical technique used is primarily based on the bones and soft tissues affected or on the level of the fracture that has occurred.

If left untreated, hip fracture may lead to complications that can be life-threatening.

Hip fracture can be prevented by taking certain steps to maintain bone density and by avoiding falls.

Signs and symptoms of a hip fracture include:

• Inability to lift, move or rotate your leg immediately after a fall
• Severe pain in your hip or groin area
• Inability to walk or put weight or pressure on your leg on the side of your injured hip
• Stiffness, bruising and swelling in and around your hip area
• The leg on the side of your fractured hip may appear shorter
• Injured leg will be held in a still position with your foot and knee turning outwards

Hip fractures are commonly caused by a fall. In older people, falls are common due to health problems such as reduced vision and balance problems.

A severe impact, for example, from a motor vehicle crash can cause hip fractures in people of all ages. In people with osteoporosis (weak and fragile bones), a hip fracture can occur even while standing on the leg and twisting.

Other possible causes of hip fractures include:

• Falls from a great height onto a hard surface
• Obesity, which leads to excessive pressure on the hip bones

After receiving diagnosis of hip fracture from your primary care physician, you may be referred to an orthopedic surgeon for further treatment.

What to expect from your doctor?

Your doctor may ask the following questions:

• Did you have a fall or other injury to your hip recently?
• How severe is your pain?
• Are you able to put weight on your leg on the side of your injured hip?
• Have you undergone a bone density test?
• Do you have any other medical conditions?
• What medications are you currently taking, including vitamins and supplements?
• Do you drink alcohol or use tobacco products?
• Have you undergone any surgery?
• Were there any problems?
• Do any of your close relatives — such as a parent or sibling — have had bone fractures or osteoporosis?
• Are you currently living independently?

Your doctor can determine that you have a hip fracture based on the obvious signs of broken hip such as swelling and bruising or a deformity.

To make an accurate diagnosis, your doctor may order tests that confirm the initial diagnosis. These tests include:

Imaging tests

These help in locating the fractures. An X-ray usually will confirm that you have a fracture and show exactly where the fracture is on your bone. If this imaging technique does not reveal any fracture, but you still have pain in your hip area, your doctor may order other imaging methods such as:

MRI or bone scan

These scans reveal hip fractures with better detail than X-rays, and help in detecting small hairline fractures.

CT scan

This is an imaging technique that creates pictures of your hip bone along with the surrounding muscles, tissues, and fat.

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

The femoral neck

This area is in the upper part of your femur, just below the ball portion (femoral head) of the ball-and-socket joint.

The intertrochanteric region

This region is located a little farther down from the actual hip joint, in the portion of your upper femur that projects outward.

An atypical fracture

A third type of hip fracture, which often occurs in people who have taken medicines that enhance bone density (bisphosphonates)for a long period of time.

Treatment strategy for hip fracture involves a combination of surgery, rehabilitation, and medication.

Surgery

The type of surgery you may have depends on the location and severity of the hip fracture, whether the broken bones are out of proper alignment (displaced fracture), your age, and underlying health conditions. The surgical treatment options are:

Internal fixation using screws

Metal screws will be inserted into the bone so that broken bones are held together while fracture healing takes place. Sometimes, screws are attached to a metal plate that extends down the femur.

Partial hip replacement: This technique is recommended if the ends of the broken bone are either displaced or damaged. In this procedure, your surgeon will remove the head and neck of the femur and implant a metal replacement in its place (prosthesis).

Total hip replacement

In this procedure, your upper femur and the socket in your pelvic bone are replaced with prostheses. Total hip replacement is considered if arthritic changes or an injury in the past has caused damage to your joint, affecting its function even before the fracture occurred.

Your doctor will advise partial or total hip replacement if the blood supply to the ball portion of your hip joint gets disrupted during the fracture. This type of injury, as it occurs most often in older people with femoral neck fractures, the bone is less likely to heal properly.

Rehabilitation

Your health care team will advise and help you out of bed and start walking slowly on the first day after surgery. Physical therapy initially focuses towards range of motion and strengthening exercises.

Depending on the type of your surgery and whether you have assistance at home, you will be shifted to an extended care facility from the hospital. In the extended care or at home, your occupational therapist will teach techniques to gain independence in daily life, such as using

• the toilet,
• bathing,
• dressing up,
• cooking.

Your occupational therapist will determine if a walker or a wheelchair will be needed to help you regain mobility and be independent.

Medication

Atleast 20% people with hip fracture are more likely to have another hip fracture within the next two years.

Bisphosphonates are a group of drugs that help reduce the risk of a second hip fracture. These drugs are taken orally and when used for a long period are associated with side effects such as acid reflux and esophageal inflammation that may be difficult to tolerate.

In order to avoid these side effects, your doctor will advise intravenous bisphosphonate treatment. Bisphosphonates are not advised in people with kidney problems. In rare cases, long-term bisphosphonate treatment may lead to

• pain and swelling in the jaw,
• vision problems,
• typical hip fracture.

You may prevent hip fractures by taking certain steps to prevent falls and by treating osteoporosis.

To reduce your risk of falling, follow these measures:

Use walking aids such as a walking stick or walker

If you do not feel stable while walking, ask your doctor or occupational therapist whether these aids can help.

Assess your home for hazards

such as:

• loose carpets,
• electrical cords,
• excess furniture,
• anything else that could make you trip and fall.

Make your home safer by ensuring that every room and passageway is well-lit.

Performing exercises that strengthen your bones and improve your balance

Weight-bearing exercises such as walking helps in maintaining your peak bone density for more years. Exercise also improves your overall strength, which results in lesser number of falls. Balance training plays an important role in reducing your risk of falls as balance deteriorates with advancing age.

Healthy lifestyle choices adopted during early adulthood helps in building a higher peak bone mass and reducing your risk of osteoporosis in the later years of life. These measures also improve your overall health if you adopt them at any age. To maintain a healthy bone: 

Get sufficient calcium and vitamin D

As a general rule, men and women of the age 50 and above should consume 1,200 milligrams of calcium a day, and 600 international units of vitamin D a day. 

Avoid smoking and drinking alcohol

Tobacco and alcohol use can reduce your bone density. Drinking excessively can also impair your balance and make you more likely to fall.

Check your vision

You have to get your eyes checked every other year, or more often if you have diabetes or an eye problem.

Watch your medications

Dizziness and weakness, which may be side effects of several medications, can increase your risk of falling. Discuss with your doctor about the side effects caused by the medications you take regularly.

Stand up slowly

Getting up too quickly may cause a sudden fall in your blood pressure and make you feel unstable.

The major factor that increases your risk of hip fractures is age. The incidences of hip fractures increases substantially with age, due to:

• Reduced bone density and muscle mass
• Vision and balance problems, which can make you fall

Other factors that can increase the risk of hip fracture include:

• Your gender: Almost 70% of hip fractures occur in women. Women are more susceptible to osteoporosis and tend to lose bone density at a faster rate than men do, mainly because of the drop in estrogen levels that occurs along with menopause that accelerates bone loss. However, men may also develop dangerously lower levels of bone density.
• Chronic medical conditions: Endocrine disorders, such as an overactive thyroid gland can lead to bone fragility. Intestinal disorders that can decrease your absorption of vitamin D and calcium can lead to weak bone and hip fracture. Cognitive impairment may also increase the risk of falling.
• Certain medications: Cortisone medications, such as prednisone, if taken for a long-term can weaken your bone. Certain drugs or combinations of medications can make you feel dizzy and more prone to falls.
• Nutritional problems or malnutrition: Lack of a healthy diet containing calcium and vitamin D during growing age can reduce your peak bone mass and put you at an increased risk of fractures later in life. Serious eating disorders such as anorexia nervosa and bulimia can cause damage to your bones as your body gets deprived of essential nutrients necessary for bone growth.
• Lack of physical exercises: Weight-bearing exercises such as walking can strengthen your bones and muscles, making falls and resultant fractures less likely. If you do not exercise regularly, you may have reduced bone density and weak bones.
• Excessive use of tobacco and alcohol: These can interfere with the normal processes of bone development and maintenance, resulting in loss of bone mass.

A hip fracture may increase your dependence and at times even shorten your life span. Almost half of the people who have had a hip fracture fail to regain their ability to live independently. If you remain immobile for a long period after hip fracture, certain complications may develop, such as:

• Formation of blood clots in your legs or lungs
• Bedsores
• Urinary tract infection
• Pneumonia
• Continuing loss of muscle mass, increasing your risk of falls and injury. In addition, people who have had a hip fracture earlier are at an increased risk of further falls, which means a significantly greater risk of having another hip fracture.