Hip Fracture: Symptoms, Causes, and Treatment

What is a hip fracture?

A hip fracture is a break in the femur that occurs in its upper part, where the bone connects to the pelvis. This type of fracture typically involves the part of the femur just below the hip joint. A hip fracture can be intra-articular (within the joint) or extra-articular (outside the joint), depending on the fracture's location. It is often caused by falls or severe impacts, especially in older adults whose bones have become brittle and more susceptible to injury due to osteoporosis.

Hip fractures can be classified as stable or unstable. Stable fractures involve minimal bone displacement, whereas unstable fractures can result in significant displacement of bone fragments, requiring more complex treatment. A hip fracture requires immediate medical attention, as inadequate treatment can lead to long-term complications, including loss of mobility, chronic pain, and even increased mortality due to secondary complications.

Symptoms of a hip fracture

A hip fracture is often a painful injury that can significantly impact an individual’s mobility and ability to perform daily tasks. The symptoms of a hip fracture are apparent and include the following:

• Severe pain in the hip or groin: The most common symptom of a hip fracture is intense pain located in the hip or groin area. The pain is usually very pronounced and worsens when attempting to move the leg or stand. The pain may also radiate down the leg, causing discomfort that affects the entire lower extremity. The pain is often constant and does not subside even when the leg is at rest, making sleeping and resting difficult.
• Inability to stand or walk: People with a hip fracture typically cannot stand or walk due to severe pain and instability in the hip. Attempting to get up or walk results in intense pain and the feeling that the leg cannot support body weight. This symptom is characteristic of a fracture, as movement becomes impossible without support. The inability to move requires immediate medical attention to prevent further injuries and complications.
• Visible deformity or unusual position of the leg: After a hip fracture, a visible deformity of the affected leg may be noticeable. The leg may appear shorter and rotated outward, which is caused by the displacement of the fractured bones. This deformity is a common sign of a fracture, indicating the need for immediate medical intervention. Such a visible change in leg position is typically due to joint instability and the inability to maintain proper bone alignment.
• Swelling and bruising: Swelling and bruising around the hip or thigh area are common after a hip fracture. Swelling is caused by inflammation and bleeding due to injury to the bone and soft tissues. Bruising may appear around the hip and spread to the thigh over time. The affected area may be painful to touch due to the swelling and bruising, further contributing to discomfort.
• Sensation of instability: People with a hip fracture often feel instability in the affected leg. The sensation that the leg cannot support body weight is characteristic of this injury and results from the disrupted structures that provide hip stability. Instability increases the risk of additional falls and injuries, necessitating prompt treatment.

The symptoms of a hip fracture are usually very pronounced, making it easy to identify the need for immediate treatment. If you notice these symptoms in yourself or someone else, it is important to seek medical attention promptly, as hip fractures require urgent care.

Causes of a hip fracture

A hip fracture can be caused by various factors, with some people being at higher risk for this injury. The causes of a hip fracture include:

• Falls: The most common cause of hip fractures in older adults is falls. With aging, the risk of falls increases due to reduced balance, muscle weakness, and poor coordination. Falls onto the side or direct impact on the hip often result in a fracture, particularly in individuals with weak bones. The risk of falling is also heightened by poor vision, the use of certain medications that cause dizziness, and various chronic health conditions.
• Osteoporosis: is a condition that causes a loss of bone density, making bones brittle and more prone to fractures. Osteoporosis is particularly common in older women, putting them at higher risk for hip fractures. Reduced bone density means that even minor stress, such as a slip or sudden twist, can cause a fracture. Treating osteoporosis, such as taking calcium and vitamin D supplements and medications to increase bone density, can help reduce the risk of fractures.
• Car accidents or severe impacts: In younger individuals with healthy bone density, hip fractures are often the result of severe trauma, such as car accidents or high-impact injuries during sports. A strong impact can cause a fracture, even if the bones are healthy and strong. This type of fracture is often complex and requires immediate surgical intervention, as fractures caused by severe impacts are frequently associated with additional injuries.
• Reduced mobility and physical fitness: People with reduced physical activity, weak muscles, and poor mobility are at greater risk for falls and subsequent fractures. Lack of exercise contributes to a loss of muscle strength and poor balance, increasing the likelihood of falls. Regular physical activity, including exercises to strengthen muscles and improve balance, can help reduce the risk of falls and fractures.
• Other risk factors: The risk of a hip fracture is also increased by other factors such as smoking, alcohol consumption, poor diet (lack of calcium and vitamin D), and chronic illnesses such as Parkinson’s disease, diabetes, and arthritis. These factors affect overall bone health and increase the risk of injury. Smoking and alcohol reduce the body's ability to absorb calcium, which can lead to weakened bones and a higher risk of fractures.

A hip fracture most commonly occurs in older adults due to age-related changes in the body and reduced bone density. However, younger people may also experience a hip fracture if exposed to severe injuries or certain medical conditions.

Treatment options for a hip fracture

Treatment for a hip fracture depends on the type and severity of the fracture as well as the patient’s overall health. The goal of treatment is to restore hip mobility and functionality while minimizing the risk of complications. Treatment options include:

• Surgery: In most cases, surgery is required as conservative treatments (non-surgical) are usually unsuccessful. Different surgical procedures are available depending on the type of fracture:
  • Internal fixation: This procedure involves using metal screws, plates, or nails to stabilize the broken bones. It is used for fractures where the bone fragments can be realigned and stabilized. Internal fixation enables quick mobilization of the patient, reducing the risk of complications such as blood clots or pneumonia.
  • Partial or total hip replacement (arthroplasty): For more complex fractures or patients with severe osteoporosis, partial or total hip replacement may be required. This involves replacing damaged parts of the hip with artificial implants, restoring functionality and reducing pain. Arthroplasty is particularly beneficial for patients whose hip joint showed signs of wear or degeneration before the fracture.
• Physiotherapy and rehabilitation: After surgery, physiotherapy is crucial to help patients regain strength, mobility, and balance. Physiotherapists provide tailored exercises to strengthen the leg muscles and improve hip mobility, allowing a gradual return to normal activities. Rehabilitation also includes learning proper walking techniques using aids such as walkers or crutches to prevent re-injury. Physiotherapy is essential to prevent muscle atrophy, which is often caused by prolonged immobility after a fracture.
• Conservative treatment: In rare cases where surgery is not possible due to medical reasons, conservative treatment is used. This involves the use of braces or slings to stabilize the hip and extended bed rest. However, such treatment often leads to complications like thrombosis, pneumonia, or muscle atrophy and is only used when surgery is not feasible. Conservative treatment requires careful monitoring by medical staff to avoid complications and ensure the best possible recovery.
• Pain management and complication control: During the treatment of a hip fracture, medications are used to relieve pain, reduce inflammation, and prevent infections. Preventing complications such as blood clots is also crucial, so the doctor may prescribe anticoagulants (blood thinners) and recommend specific exercises to improve circulation. Regular monitoring and management of potential complications such as pressure sores from prolonged lying are also important.

Treating a hip fracture requires a comprehensive approach that includes surgery, rehabilitation, and support to prevent complications. Timely treatment and appropriate rehabilitation lead to better outcomes and reduce the risk of long-term issues and disability.