Hip Fracture

A hip fracture is a break at the upper end of the thighbone, and it is among the most serious orthopedic injuries an older adult can sustain. It causes severe pain and makes bearing weight impossible. Most happen when an older adult with bone weakened by osteoporosis falls from standing height; a smaller group is younger patients with high-energy injuries. The fracture is named by where the break occurs, which shapes the operation. With surgery and timely rehabilitation, most patients are able to walk again and return to many of their prior activities.

Common symptoms include:

• Severe groin or hip pain after a fall
• Inability to bear weight or stand back up
• A leg that appears shortened and rotated outward
• Groin pain worse with movement but tolerable at rest, with a nondisplaced fracture
• Being found on the floor without a clear memory of falling

Evaluation begins with a history and physical exam, including the position of the leg and a check of nerve and blood vessel function. Plain X-rays of the pelvis and a lateral view of the hip make the diagnosis in most cases. When X-rays are negative but a fracture is still suspected, an MRI is used, because it can detect a fracture line before the patient walks on it and shifts it.

Treating a hip fracture without surgery is uncommon. It is reserved for patients whose medical condition makes surgery more dangerous than the fracture, or for the rare stable pattern unlikely to shift, and involves:

• Strict activity limitation
• Pain management
• Close follow-up with repeat imaging to confirm the fracture has not moved

For nearly every adult who can tolerate an operation, surgery is the appropriate treatment, because prolonged bed rest carries greater medical risk. The operation is matched to the fracture: most are fixed with screws, a sliding screw and plate, or a nail, while a displaced break through the neck of the bone, just below the ball, is often treated by replacing the ball, frequently with a partial replacement rather than a total one.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Hip Fractures — AAOS OrthoInfo