Hip Fracture

Last updated March 17, 2017

What are the other Names for this Condition? (Also known as/Synonyms)

  • Femoral Neck Fracture
  • Intertrochanteric Hip Fracture
  • Proximal Femoral Fracture 

What is Hip Fracture? (Definition/Background Information)

  • A Hip Fracture is a serious injury that occurs, when the thigh bone (femur) breaks or cracks, near the hip joint. Hence, such fractures are also called Proximal Femoral Fractures
  • This type of fracture and certain complications associated with them may be life-threatening, if the injury occurs in individuals over the age of 65 years
  • However, surgical intervention has proven to be a successful method for treating this complicated condition. The healing process usually requires time, physical therapy, and patience

There are 2 different types of Hip Fractures, and these include:

Femoral Neck Fracture:

  • A Femoral Neck Fracture is a fracture that occurs between 1-2 inches from the hip joint
  • Such fractures usually occur in elderly individuals affected by osteoporosis

Intertrochanteric Hip Fracture:

  • An Intertrochanteric Hip Fracture is an injury that occurs between 3-4 inches from the hip joint
  • However, this type of fracture does not disrupt blood flow to the bone. And since the disruption of blood flow to the bone does not occur, this injury usually can be repaired without the need for a hip replacement surgical procedure 

Who gets Hip Fracture? (Age and Sex Distribution)

  • Hip Fractures may occur in individuals of all ages, races, ethnic groups, and gender
  • Generally, elderly adults over 65 years old, have a high incident rate of this injury
  • Women (after menopause) are more likely to sustain such fractures than men; the female-male ratio varies between 1.5-3:1, with the higher value noted among Caucasians
  • Caucasians and Asians are also known to have a high prevalence of this type of fracture, due to a higher rate for osteoporosis, observed amongst them; while Afro-Americans have a much lesser incidence 

What are the Risk Factors for Hip Fracture? (Predisposing Factors)

Risk factors associated with Hip Fractures include:

  • Age: Individuals over the age of 65 years are higher prone to this type of fracture, due to weaker bones
  • Gender: Women are much more likely to experience a Hip Fracture than men, due to a drop in estrogen levels associated with menopause, which accelerates bone loss
  • Osteoporosis, an age-related degenerative disease that causes weak bones is the most noteworthy and recognized risk factor associated with Hip Fractures
  • Other medical conditions: However, other medical conditions that may increase the risk of bone fragility include an overactive thyroid and gastrointestinal disorders, which may reduce the absorption of vitamin D and calcium in the body
  • Poor vision: Age-related vision deterioration or vision loss is another prime factor for fall-related Hip Fractures
  • Corticosteroid medication: Prolonged consumption of steroidal medications may increase the risk
  • Reduced vitamin consumption: Decreased levels of calcium and vitamin D in the diet of children and adolescents can reduce their maximum bone mass and increase the possibility of such a fracture
  • Physical inactivity: Physical inactivity, such as due to prolonged bed rest or immobility, may lead to bone loss
  • Alcohol addiction: Excessive consumption of alcohol may increase the risk
  • Tobacco use: Researchers have found that smoking can lead to bone loss, which can increase the risk of a Hip Fracture

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Hip Fracture? (Etiology)

A few causes associated with a Hip Fracture include:

  • Falls: A very high percentage of Hip Fractures result from a direct fall
  • Direct trauma: Any significant traumatic event, such as an automobile, motorcycle, or bicycle accident
  • Corticosteroid medication: Prolonged consumption of steroidal medications, such as prednisone, may weaken the bone causing a Hip Fracture 

What are the Signs and Symptoms of Hip Fracture?

The signs and symptoms usually depend on the severity of the hip fracture, and these may include:

  • Severe pain in the hip, groin region
  • Bruising around the hip joint
  • Swelling and tenderness
  • Difficultly walking, standing; inability to stand
  • Noticeable shortening of the leg on the side of the injury may be observed, due to movement of fractured bone
  • Immobility right after a fall or accident 

How is Hip Fracture Diagnosed?

Common tests a physician may use to diagnose a Hip Fracture include:

  • Physical examination: Usually, a thorough physical examination can help diagnose the condition
  • X-ray of hip joint: X-rays may determine the extent of the fracture, help identify the exact location, and how the fracture affects surrounding bones and joints
  • Computerized tomography (CT) scan of hip joint: A physician may order a CT scan, which helps take a more detailed image of the hip
  • Magnetic resonance imaging (MRI) of hip joint: An MRI scan is a more detailed scan that uses radio waves and a magnetic field to produce images that allow a physician to view any damage to the bones and soft tissue that surrounds the hip 

What are the possible Complications of Hip Fracture?

A Hip Fracture is a serious, but treatable injury. However, some complications associated with this fracture may be life-threatening. These may include:

  • Pulmonary embolism, blood clots
  • Bedsores, due to long duration stay in bed
  • Urinary tract infection
  • Muscle atrophy, due to decreased physical activity
  • Lung infection (pneumonia) 

How is Hip Fracture Treated?

The treatments associated with a Hip Fracture depend on the severity of the injury. Both conservative methods and surgical treatment measures are available; although, a surgery is required in most cases.

Some non-surgical treatment measures for a Hip Fracture include:

  • Rest: Any activity that aggravates the hip condition further should be avoided. A physician may advise a patient to refrain from participating in any activity, until the symptoms improve
  • Splint or brace: A physician may prescribe a padded brace covering the hip to limit movement and help the injury to heal
  • Ice: Applying ice to the hip should help reduce any pain
  • Non-steroidal anti-inflammatory medication: Medications, such as ibuprofen and naproxen, can help decrease the hip pain

Surgical treatment for a Hip Fracture depends on the area of the fracture or break. Different surgical procedures associated with a Hip Fracture include:

  • Open reduction and internal fixation (ORIF) of Hip Fracture: Open reduction and internal fixation is a surgical intervention tool to realign the fractured bone into its original position. An internal fixation device is used to hold the bone together, until it is fully healed. Different internal fixation devices, such as plates, screws, and rods, may be used to hold the bone together
  • Hemiarthroplasty of hip joint: Hemiarthroplasty is a surgical intervention technique that involves a partial removal of the hip joint. In this procedure, only the ball section of the hip joint is removed and not the socket portion. The partially removed joint is then replaced by a prosthetic metal implant
  • Total hip arthroplasty: Total hip arthroplasty is a surgical procedure that involves the complete removal of the hip joint. The removed arthritic hip joint is then replaced by a metal and plastic prosthetic implant. A physician will recommend this surgical procedure, if this joint fracture affects the entire hip joint 

How can Hip Fracture be Prevented?

It is always recommended to be careful and consciously aware, while performing any physical activities such as, sports, or even some normal daily activities that could lead to situations involving accidents. Children must be provided a safe environment to work, study or play; any probable dangers involved should be anticipated and safety measures adopted.

A few ways to further help prevent unwanted injuries or a Hip Fracture include:

  • Build bone strength: Foods rich in calcium, such as milk, yogurt, and cheese, help build bone strength. Regular diet with an appropriate calcium intake is recommended. In women, the recommended amount of calcium increases with age and menopause
  • Prevent falls: Wearing appropriate footwear, such as the proper shoe size, may help prevent accidents resulting in a Hip Fracture
  • Use protective gear: Individuals, who participate in any high-risk sports, such as football, should wear appropriate safety equipment to help prevent the possibility of any injury or fracture
  • Reduce or stop the intake of alcohol and tobacco 

What is the Prognosis of Hip Fracture? (Outcomes/Resolutions)

  • A Hip Fracture is always a serious injury and may cause permanent disability in individuals
  • Elderly adults, who sustain a severe Hip Fracture, it may result in a life-threatening complication
  • However, if properly treated and rehabilitated, most patients usually regain their full strength and range of motion after the injury 

Additional and Relevant Useful Information for Hip Fracture:

  • A fracture of the distal femur (thigh bone) is a break or crack that occurs anywhere within the lower region of the femur (near the knee) 

The following article link will help you understand distal femur fractures.
http://www.dovemed.com/diseases-conditions/fracture-of-the-distal-femur/

What are some Useful Resources for Additional Information?

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Rd. Rosemont, IL 60018-4262
Phone: (847) 823-7186
Toll-Free: (800) 346-2267
Fax: (847) 823-8125
Email: hackett@aaos.org
Website: http://www.aaos.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases
1 AMS Circle Bethesda, MD 20892-3675
Phone: (301) 495-4484
Toll-Free: (877) 226-4267
TTY: (301) 565-2966
Fax: (301) 718-6366
Email: NIAMSinfo@mail.nih.gov
Website: http://www.niams.nih.gov

References and Information Sources used for the Article:

http://orthoinfo.aaos.org/topic.cfm?topic=A00392 (accessed on August 29, 2014)

http://www.mayoclinic.com/health/hip-fracture/DS00185 (accessed on August 29, 2014)

http://www.cdc.gov/HomeandRecreationalSafety/Falls/adulthipfx.html (accessed on August 29, 2014)

http://www.nlm.nih.gov/medlineplus/ency/imagepages/18026.htm (accessed on August 29, 2014)

http://www.nlm.nih.gov/medlineplus/ency/article/007386.htm (accessed on March 29, 2013) 

Helpful Peer-Reviewed Medical Articles:

Alsawadi, A., & Loeffler, M. (2012). Graduated compression stockings in hip fractures. Ann R Coll Surg Engl, 94(7), 463-471. doi: 10.1308/003588412X13171221592492

Chaudhry, H., Devereaux, P. J., & Bhandari, M. (2013). Cognitive dysfunction in hip fracture patients. Orthop Clin North Am, 44(2), 153-162. doi: 10.1016/j.ocl.2013.01.003

Leigheb, F., Vanhaecht, K., Sermeus, W., Lodewijckx, C., Deneckere, S., Boonen, S., . . . Panella, M. (2012). The effect of care pathways for hip fractures: a systematic review. Calcif Tissue Int, 91(1), 1-14. doi: 10.1007/s00223-012-9589-2

Palmer, J. S., & Huber, C. P. (2012). Operative management of hip fractures: a review of the NICE guidelines. Br J Hosp Med (Lond), 73(9), C141-144.

Parker, M. J., & Das, A. (2013). Extramedullary fixation implants and external fixators for extracapsular hip fractures in adults. Cochrane Database Syst Rev, 2, CD000339. doi: 10.1002/14651858.CD000339.pub3

Yang, S., Cao, L., Cai, S., Yuan, J., & Wang, J. (2012). A systematic review of growth hormone for hip fractures. Growth Horm IGF Res, 22(3-4), 97-101. doi: 10.1016/j.ghir.2012.03.002

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Sept. 2, 2014
Last updated: March 17, 2017

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