What is a hip fracture?

A hip fracture is a break high up in the thighbone (femur) near the hip joint. It is a serious and painful condition that requires immediate medical attention.

Hip fractures mostly occur in people over 65 years of age, usually due to a fall. In Australia, more than 17,000 people have a hip fracture every year. [1]

Hip fractures can lead to frailty, loss of mobility and independence and an increased risk of death. However, there are many things that can be done to prevent falls and reduce your risk of having a hip fracture.

1. Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from

External link

Hip joint

The hip joint is made up of:

  • A  cup-shaped hip socket (acetabulum) of the pelvis, and;
  • The ball-shaped head of the thighbone (femur).

The head of the femur sits inside the acetabulum and is able to rotate freely, which gives the hip its wide range of movement. The joint is surrounded by strong ligaments that helps provide support.

Various bones of the hip and locations of possible fractures. 

Ligaments

Short, flexible fibrous tissue that connects the bones and cartilage of joints.

Pelvis

The bony structure in the lower part of the body trunk that connects the base of the spine to the legs. The pelvis protects important organs, such as the bladder and bowel (and in women, the uterus), and anchors thigh and abdominal muscles.

1. Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from

External link

Risk factors

A hip fracture occurs when there is sufficient force through the hip joint, which is more than what the bones can withstand. The bone may develop a crack or break completely, which usually occurs at its weakest point. The amount of force needed to fracture bones usually reduces with advancing age, as bones naturally lose their strength. Underlying bone conditions such as osteoporosis can further increase the risk for hip fractures. 

Falls from a standing position and mild trauma are common causes of hip fractures in the elderly population. In younger people, most hip fractures are due to high-impact injuries, such as from car collisions or falling from a height.

Factors that can increase the risk of falling include:

  • Loss of muscle associated with ageing;
  • Problems with walking and mobility;
  • Balance problems and poor reaction times;
  • Some medications, particularly those used to treat high blood pressure, depression, anxiety and problems with sleeping. This is particularly the case when people are taking multiple medications;
  • Low blood pressure, which can lead to dizziness or fainting;
  • Vision loss or impairment, and;
  • Dementia and cognitive (thinking) problems.

Dementia

A collection of symptoms caused by permanent disorders of the brain. People with dementia lose their ability to think and reason clearly, which has an impact on their daily functioning.

1. Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from

External link

Types of hip fractures

A hip fracture can occur at:

  • The neck of the femur. This is sometimes called an intracapsular fracture, because it occurs inside the hip joint capsule; 
  • Between the trochanters (the bony lumps on the femur where muscles attach);
  • Below the trochanters, or; 
  • Fractures of the hip socket (the acetabulum) can also occur. These are less common and tend to be caused by high-impact accidents or in those with bones weakened by osteoporosis.

In more severe injuries, there may be fractures at more than one location in the hip. The position of a fracture may influence what kind of treatment is required. 

1. Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from

External link

Signs and symptoms

Symptoms of a hip fracture can include:

  • Severe pain around the injured hip and groin;
  • Being unable to move or lift the injured leg;
  • Bruising and swelling around the hip;
  • The injured leg may appear shorter, and;
  • The injured leg may tend to turn outwards.

Most people with a fractured hip will be unable to stand or put weight on the leg on the affected side. There may also be other associated injuries that need investigation and treatment. 

A fractured hip is a serious condition that requires prompt medical attention.

1. Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from

External link

Methods for diagnosis

Most individuals suspected of having a hip fracture are taken to an emergency department for investigations and treatment. Your doctor will likely ask how the injury happened, as well as perform a thorough physical examination to help diagnose a hip fracture, assess for other injuries and exclude an underlying medical condition for the fall, such as a heart attack or stroke. 

Imaging tests are used to confirm the hip fracture, its type and the extent of the fracture. The most common tests are X-rays and computerised tomography (CT) scan.

You are likely to also have the following:

  • Pain relief to make you more comfortable;
  • Intravenous fluids to prevent dehydration. You may be asked to fast, if you need surgery;
  • Rest in bed, and
  • A urinary catheter to help pass urine, which can otherwise be difficult if you are bedbound.

Catheter

A thin, flexible tube inserted through a narrow opening into a body cavity for removing fluid.

Computerised tomography

A scan that uses X-rays to create a 3D image of the body. This can detect abnormalities more effectively than a simple X-ray can.

Intravenous

Within a vein.

X-rays

A scan that uses ionising radiation beams to create an image of the body’s internal structures.

1. Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from

External link

Types of treatment

The definitive treatment for a hip fracture is surgery. This is usually done soon after the injury (within a day or so) to help improve healing. There are numerous types of surgery that can be performed, which depends on:

  • The position of the fracture;
  • The condition of the hip joint prior to the injury and whether it is affected by arthritis, and;
  • Your age, level of mobility and whether you have any cognitive problems such as dementia.

Types of surgical techniques include:

  • Internal fixation - in this procedure, pins, screws, rods and/or plates are used to hold the fracture together to allow it to heal;
  • Hemiarthroplasty - this procedure is also called a partial hip replacement and involves replacing the head of the femur with a prosthesis (an artificial piece), and;
  • Complete hip replacement - this procedure, commonly called a hip replacement, involves replacing both the head of the femur and the socket of the hip joint (acetabulum).

A specialised surgeon, called an orthopaedic surgeon, performs the procedure and can discuss which option is most suitable for a particular individual. Surgery for a hip fracture usually takes around two hours. It can be performed under general anaesthetic or under regional anaesthetic, in which only the lower part of the body is numbed. Regional anaesthesia may be used when administration of a general anaesthetic poses a significant risk, particularly in those who are frail and have multiple medical conditions.

What happens after the surgery?

After surgery, you will usually be encouraged to get out of bed and become mobile again. Staff such as physiotherapists and nurses will help you with this to make sure that you move safely and do not fall.

A rehabilitation program can help you recover from the hip injury and become more independent with tasks involved in looking after yourself. Depending on your health, you may do some of your rehabilitation in hospital, at a rehabilitation unit or at home after you are discharged from hospital. Full recovery from a hip fracture can take a couple of months to a year.

Your rehabilitation program can be tailored to your particular needs and circumstances. It may involve a range of health professionals such as doctors, physiotherapists, occupational therapists, nurses and social workers.

Rehabilitation will often include doing various kinds of exercise, depending on your fitness and health. It may also include an assessment of your home, to see if things can be changed to reduce your risk of falling again.

If you have osteoporosis, treating this condition may help to prevent more fractures happening in the future. Your doctor can advise you on the most appropriate treatment of the osteoporosis. 

Rehabilitation: A physiotherapist helping a patient walk with the assistance of hand rails.A rehabilitation program, after hip replacement, assists recovery. 

Dementia

A collection of symptoms caused by permanent disorders of the brain. People with dementia lose their ability to think and reason clearly, which has an impact on their daily functioning.

General anaesthetic

An anaesthetic given to a person to put them to sleep while having an operation or medical procedure. Afterwards, the person regains consciousness and usually has no memory of the procedure. A general anaesthetic is given in hospital by a specialist called an anaesthetist.

Occupational therapists

A healthcare professional trained to deliver occupational therapy, which involves teaching a person self care, work and play activities to promote independence and reduce disability.

Physiotherapists

A healthcare professional trained in treating injury or disability with physical remedies, such as massage or exercise.

1. Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from

External link

Potential complications

The potential complications of having a hip fracture and recovering from surgery include: 

  • Blood clots forming in the deep veins of the legs (deep vein thrombosis);
  • Infections, such as pneumonia, urinary tract infections and wound infections; 
  • Pressure sores (sometimes called bedsores). These are ulcers that can develop because of pressure on a patch of skin when a person is unable to get out of bed or a chair, and;
  • Weakness and deconditioning due to lack of muscle use.

Becoming mobile soon after surgery can help reduce the risk of these complications. Medications to prevent blood clotting and wearing pressure stockings on your legs can also help to prevent these kinds of problems.

Some people, despite rehabilitation, are unable to make a full recovery. They may not be able to return home and live independently, in which case they may need to move to residential aged care or a nursing home.

Ulcers

An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.

Clotting

The process by which blood changes from a liquid to a semi-solid state, usually to seal off any sites of bleeding. This is also known as coagulation.

1. Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from

External link

Prognosis

Several factors, such as age and general health, can influence recovery. Participating in a rehabilitation program can greatly aid a return to physical activity.

1. Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from

External link

Prevention

Ways to prevent hip fractures include:

  • Preventing or treating osteoporosis, and;
  • Taking steps to prevent falls from occurring.

There are many things that can be done to prevent falls. These can include:

  • Exercises and training to promote better balance and mobility;
  • Making sure your medication levels are appropriate for your needs, particularly if you are taking many medications;
  • Having an occupational therapist assess your home and yard. Removing tripping hazards and installing balance aids, such as hand rails, where they are needed;
  • Making sure your vision is as clear as possible and wearing appropriate prescription glasses, if needed, and;
  • Dealing with foot problems and wearing suitable footwear.

You can talk to your doctor about reducing your risk of falling and services that may be available if you need help. 

Occupational therapist

A healthcare professional trained to deliver occupational therapy, which involves teaching a person self care, work and play activities to promote independence and reduce disability.

1. Australian & New Zealand hip fracture registry. Accessed 11 November 2014, from

External link