Hip fracture

A hip fracture is a break in the upper part of the femur, which is the thigh bone. This injury typically occurs at the femoral neck, but it can also happen at the femoral head.

Because the hip is a critical weight-bearing joint, a fracture is a serious medical event. It often results in an inability to bear weight or walk. Patients frequently experience significant pain in the groin area. A classic sign is that the affected leg may appear shorter than the other. The leg might also rotate unnaturally toward the outside.

The hip joint is a complex ball-and-socket mechanism. The head of the femur fits into a socket in the pelvis called the acetabulum. This connection is kept stable by ligaments, cartilage, and a structure called the labrum. The labrum lines the acetabulum to provide shock absorption and stability. Several ligaments, such as the iliofemoral and ischiofemoral ligaments, help prevent the joint from moving too far in certain directions. When a person falls, the hip experiences combined mechanical loads. These include axial loads that create compressive stress and bending loads that create tensile stress. If the bone is weak, these forces can cause the femur to snap.

Fractures are classified based on where they occur in the bone. Intracapsular fractures happen inside the joint capsule, such as at the femoral head or neck. These are risky because they can interrupt the blood supply, leading to avascular necrosis. This is a condition where bone tissue dies due to lack of blood.

Extracapsular fractures occur outside the joint capsule. These include trochanteric fractures, which happen near the bony bumps called trochanters. There are also subtrochanteric fractures located just below that area. Different types of fractures, like subcapital or transcervical, describe exactly where the break sits along the femoral neck.

Most hip fractures in older adults result from low-energy falls. When an elderly person falls to their side, the risk of a fracture increases significantly. For elderly males, a sideways fall increases risk 15-fold. For females, the risk increases 12-fold. Several factors can make bones more fragile and prone to these breaks. Osteoporosis is a major risk factor that weakens the bone structure. Other causes include certain medications, alcohol use, or metastatic cancer, where cancer spreads to the bone. Even metabolic diseases like Paget's disease can weaken the femur.

Doctors use several imaging tools to diagnose a fracture. X-rays are usually the first step, often taken from the front and the side.

If an X-ray is not clear, an MRI is the preferred next step because it is very sensitive. A CT scan can be used if an MRI is not available. Sometimes a bone scan is used, though it can be less accurate in older patients. Before surgery, doctors also perform general checks, such as blood tests and heart exams, to ensure the patient is stable.

Surgery is generally recommended within two days of the injury if the patient's health allows.

One surgical option is to stabilize the fracture using screws to hold the bone pieces together.

Another option is a total hip replacement, where the damaged joint is replaced with a prosthesis. Doctors also use pain management techniques, such as opioids or regional nerve blocks. Nerve blocks can be especially helpful because they may reduce the risk of lung infections and help patients move sooner.

Recovery involves managing several serious complications. One major risk is thromboembolism, which includes blood clots. A deep venous thrombosis (DVT) occurs when a clot forms in a leg vein. If that clot travels to the lungs, it causes a pulmonary embolism (PE), which can be fatal.

Patients also face risks from being immobile, such as pressure sores or urinary tract infections. Mental confusion, known as delirium, is also very common due to pain and the stress of surgery. Because of these risks, doctors advocate for early mobilization to help the body heal and prevent further illness.