Conditions

Introduction to Hip Fractures

A hip fracture is a serious injury where one of the bones that make up the hip joint breaks. It typically happens in the upper part of the femur (the thigh bone) and is more common in older adults, though anyone can suffer from it. Hip fractures can happen due to a fall, an accident, or other trauma, and they can significantly affect a person’s ability to move and carry out daily tasks. Early diagnosis by an experienced orthopaedic surgeon, followed by appropriate treatment and rehabilitation, are essential for a good recovery.

General Anatomy of the Hip

The hip joint is a ball-and-socket joint located where the femur (thigh bone) meets the pelvis. The two main bones involved in the hip joint are:

1. Femur: The long bone of the thigh that has a rounded head (the ball) that fits into the acetabulum (the socket) in the pelvis.
2. Pelvis: The large bone structure in the lower part of the torso that supports the weight of the upper body when sitting and standing.

The ball-and-socket structure allows for a wide range of motion, including walking, running, and sitting down. The hip joint is surrounded by strong ligaments and muscles that provide stability and control. The femoral neck is the part of the femur just below the ball and is the area where hip fractures most commonly occur.

Causes of Hip Fractures

Hip fractures most commonly occur in older adults, especially those with osteoporosis, a condition where bones become weak and brittle. However, anyone can experience a hip fracture, especially if they fall or suffer trauma. Here are some common causes:

1. Falls: A fall is the most common cause of a hip fracture, particularly if the person falls sideways onto the hip.
2. Osteoporosis: As we age, bones can become weaker, making them more prone to breaking, even from minor falls.
3. Car Accidents: A strong impact during a car accident can cause a fracture of the hip.
4. Sports Injuries: High-impact sports, such as football, soccer, or skiing, can also lead to hip fractures due to a direct blow or twisting injury.

Types of Hip Fractures

There are several fractures that may occur around the hip. This may involve the femoral neck, the area around the trochanters or below the trochanter.

Neck of Femur fractures are graded based on how severe and displaced the fracture is. Treatment options depend on this grading.

Intertrochanteric fractures happen between the greater and lesser trochanters. They are graded on the number of fracture fragments as well as their location.

 The greater the number of fracture fragments, the more complex it is to fix the fracture with implants.

Symptoms of a Hip Fracture

When someone experiences a hip fracture, they usually have the following symptoms:

• Hip Pain: Severe pain in the hip or groin area, especially when trying to move or put weight on the leg.
• Inability to move the leg: It may be difficult or impossible to lift or move the leg.
• Swelling and bruising: The hip or thigh may become swollen or bruised due to the injury.
• Deformity: The leg may appear shorter than the other leg or may turn outward, depending on the type of fracture.
• Difficulty walking: If the fracture is severe, the person may not be able to walk or stand without help.

Investigations for Hip Fractures

To confirm whether someone has a hip fracture, the doctor will perform a physical examination and request imaging tests. Here’s how hip fractures are typically diagnosed:

Physical Examination:

• • The doctor will check for pain, swelling, and any abnormal positioning of the leg.
  • They may gently try to move the leg to see if it causes pain or discomfort.

X-rays:

• • An X-rayis the most common and effective way to diagnose a hip fracture. It provides clear images of the bones and allows the doctor to see if there’s a break in the femur or pelvis, and if the bones are misaligned.
    

X-ray showing a displaced right femoral neck fracture (Garden 4)

CT Scan or MRI:

• • If the fracture is hard to detect with an X-ray or if more details are needed, the doctor might recommend a CT scanor MRI. These provide more detailed images of the bone and surrounding tissues, especially soft tissues like muscles and ligaments.

Treatment Options for Hip Fractures

The treatment for a hip fracture depends on the type, location, and severity of the fracture. Treatment generally falls into two categories: non-surgical and surgical.

Non-Surgical Treatment (Rare for Hip Fractures)

• Bed Rest and Pain Relief: For very minor fractures (which are rare in the hip area), the doctor may suggest rest, ice, and medication to manage pain.
• Physical Therapy: If the fracture is very stable and doesn’t require surgery, physical therapy may be part of the treatment plan to strengthen the muscles around the hip.

Surgical Treatment (Most Common for Hip Fractures)

Most hip fractures require surgery to repair the bones and restore mobility. The goal of surgery is to realign the bones and hold them in place while they heal. There are two main types of surgery:

• Internal Fixation: In this procedure, the surgeon uses screws, plates, or rods to hold the broken parts of the femur in place while the bone heals. This type of surgery is often used for fractures in the femoral neck.

Undisplaced or minimally displaced femoral neck fractures may be fixed with screws or other implants.

Inter-trochanteric fractures may be fixed with intramedullary nails and screws to allow patients to start their rehab immediately after.

• Hip Replacement: In more severe fractures, especially in older adults or if the bone is severely damaged, a total hip replacement may be performed. In this surgery, the damaged part of the hip joint is replaced with a prosthetic joint.

Hip replacements are performed in elderly patients with displaced femoral neck fractures. This allows them to return to walking and other functions earlier.

Rehabilitation and Recovery

Rehabilitation is a critical part of the recovery process following a hip fracture. The goal of rehab is to restore movement, strength, and balance in the hip joint.

Physical Therapy:

• Range of Motion Exercises: In the first phase of rehabilitation, gentle exercises are used to improve the range of motion in the hip joint. These exercises help prevent stiffness and improve flexibility.
• Strengthening Exercises: Once the bones have healed enough, physical therapy will focus on strengthening the muscles around the hip and leg to help with stability and mobility.
• Balance and Walking Exercises: Physical therapists also focus on improving balance and teaching patients how to walk safely and confidently with the help of walking aids, such as crutches or a walker.

Gradual Return to Activity:

• Rest and Follow-Up Care: After surgery or non-surgical treatment, it’s important to rest and avoid putting too much weight on the hip. Follow-up visits to the doctor will ensure that the bones are healing properly.
• Avoid High-Impact Activities: During the recovery period, patients should avoid activities that put too much strain on the hip, such as running or jumping, until they are fully recovered.

Recovery Time:

• Surgical Treatment Recovery: If surgery is required, full recovery from a hip fracture typically takes 3 to 4 months. Patients may start walking with the help of crutches or a walker soon after surgery, but weight-bearing on the leg should be gradual. Your surgeon will advise you about specific cases and its appropriate rehab program.
• Physical Therapy Duration: Rehabilitation can last for several months, and patients often continue to see improvements in strength and mobility over time.

Prevention Tips for Hip Fractures

While some fractures are unavoidable, you can reduce the risk of a hip fracture by:

• Strengthening bones: Eating a healthy diet with plenty of calcium and vitamin D, and engaging in weight-bearing exercises like walking or dancing can help keep bones strong.
• Preventing falls: Remove tripping hazards around the home, install grab bars in bathrooms, and ensure adequate lighting to prevent falls, especially as we get older.
• Wearing supportive shoes: Proper footwear can help improve balance and reduce the risk of slips and falls.

Conclusion

A hip fracture is a serious injury, but with the right treatment and rehabilitation, most people can recover and regain their mobility. Whether treated with surgery or conservative care, rehabilitation through physical therapy is essential for restoring strength and function to the hip joint. If you or someone you know experiences a hip fracture, seeking prompt medical attention is crucial for the best outcome.