The hip joint is shaped like a ball and socket. The “ball” is the femoral head (the top of the thigh bone/femur) and the “socket” is the acetabulum (pelvis), which is shaped like a cup. Ligaments, tendons and muscles hold the bones in place. A hip fracture is a break or crack in either the neck or head of the femur or in both the ball and socket. It is a serious condition that can cause a lot of pain and potentially be life-threatening. If you suspect you have broken your hip, you must seek urgent medical attention.
Hip fractures are usually caused by a fall from a high place or onto a hard surface. They can also be caused by injury or trauma, for example, in a car accident. Some people may have weakening of the bones in the joint, like with cancer or osteoporosis. Another cause or contributor can be obesity putting extra pressure on the hip joint.
Some groups of patients who are more at risk of hip fracture include:
- Older people (especially women): patients who are 60 or over and have problems with vision, mobility, balance and bone density or diseases of older age such as neuropathy (numbing), stroke or Parkinsons.
- Osteoporosis: those with Osteoporosis have bones that are more fragile.
- Malnutrition: a diet lacking in protein, Vitamin D and calcium may be a contributing factor.
- Previous hip injury: those who have broken their hip befor are more likely to break again.
Symptoms will usually occur immediately after the fall or impact and commonly include:
- Pain: generally in the hip and groin, although may also be felt in the knee.
- Immobility: unable to stand or put pressure/weight on the affected leg.
- Swelling, bruising, & inflammation
- Altered leg length or alignment: the affected leg turning outwards or being shorter than the other.
Not all of these symptoms will occur and some people find they can still walk on the affected leg.
Diagnosis is more likely to happen at an emergency hospital. Your specialist will ask questions about your medical history, whether you take any medicines and if this has happened before. It will be important to work out how it happened (for example, did you fall?), your level of pain and if you feel confused. Your hip will be examined to see what it looks like.
To help make a diagnosis and to check where or how bad the fracture is, your specialist may request a scan. An x-ray may be used to examine the bones of your hip and the space between them. If needed, an MRI (magnetic resonance imaging) may be done to produce a more detailed image of the fracture, or a CT (computerised tomography scan) to assess the muscles and tissue around the joint. Your specialist may check for other conditions, such as osteoporosis, and may request blood tests for dehydration or infection.
Emergency treatment for a hip fracture can include painkillers, the injection of a local anaesthetic into the hip to numb it, and fluids if you are dehydrated.
Non-surgical treatments are not commonly used as they often mean a person has to spend a long time in bed. Methods, such as skeletal traction, can hold the bones straight and in place while they heal, but this process can be lengthy and risks significant problems, like pressure sores and pneumonia. Physical therapy would also be used alongside to promote healing and function. Conservative treatment is usually only applied if a patient is very frail, has dementia or if the fracture is older and already healing.
Surgery to repair or replace the broken hip bones is usually the only option in terms of treatment. Unless you are otherwise unwell, it will usually occur within 48 hours of the fracture taking place. The options for surgery will normally be based on the type of break, the condition of the hip joint (for example, if you have arthritis) and your mobility before the event. Your age and level of frailty may be taken into account. All options are likely to be followed with physical therapy and possibly some time in a rehabilitation facility.
- Internal Fixation: Internal fixation refers to a group of procedures that aim to heal broken bones using implants, such as screws, rods, pins or plates. The broken bone or its fragments will be held in place with the implant to allow it to heal. The type of fixation you are recommended will depend on the type of fracture you have, as well as other factors, such as your age and mobility level. Some implants, such as the dynamic hip screw, may be removed at a later date in younger patients.
- Partial Hip Replacement (Hip Hemiarthroplasty): A partial hip replacement removes and replaces the damaged femoral head. It is replaced with a “prosthesis”, which is an artificial joint usually made of metal and plastic. Ideally, candidates for a partial hip replacement would not have significant arthritic damage to the acetabulum (pelvis). As mobility may be affected post-surgery, it can be more suitable for older or less mobile people. A total hip replacement (see below) may be advised as a more suitable option for younger or more active patients with hip fractures. Learn More
- Total Hip Replacement: A total hip replacement is an operation that uses an artificial implant joint called a “prosthesis” to replace the damaged bone. Prosthetic implants can be made of metal, ceramic or even tough plastic. The surgeon will make an incision (cut) into the hip, remove the damaged hip joint and replace it with a new artificial one. For younger patients who are still growing, the joint may need to be replaced at a later date. A total hip replacement is more likely to be performed than a partial one in younger or more mobile patients, as it can preserve function and last longer. You will likely leave the hospital with a frame or crutches. Learn More