Hip fractures most commonly occur from a fall or from a direct blow to the side of the hip. Some medical conditions such as osteoporosis, cancer, or stress injuries can weaken the bone and make the hip more susceptible to breaking. In severe cases, it is possible for the hip to break with the patient merely standing on the leg and twisting.
The patient with a hip fracture will have pain over the outer upper thigh or in the groin. There will be significant discomfort with any attempt to flex or rotate the hip.
If the bone has been weakened by disease (such as a stress injury or cancer), the patient may notice aching in the groin or thigh area for a period of time before the break. If the bone is completely broken, the leg may appear to be shorter than the noninjured leg. The patient will often hold the injured leg in a still position with the foot and knee turned outward (external rotation).
Types of Fractures
In general, there are three different types of hip fractures. The type of fracture depends on what area of the upper femur is involved.
These fractures occur at the level of the neck and the head of the femur, and are generally within the capsule. The capsule is the soft-tissue envelope that contains the lubricating and nourishing fluid of the hip joint itself.
This fracture occurs between the neck of the femur and a lower bony prominence called the lesser trochanter. The lesser trochanter is an attachment point for one of the major muscles of the hip. Intertrochanteric fractures generally cross in the area between the lesser trochanter and the greater trochanter. The greater trochanter is the bump you can feel under the skin on the outside of the hip. It acts as another muscle attachment point.
This fracture occurs below the lesser trochanter, in a region that is between the lesser trochanter and an area approximately 2 1/2 inches below .
In more complicated cases, the amount of breakage of the bone can involve more than one of these zones. This is taken into consideration when surgical repair is considered.
Surgery is done as soon as possible after a diagnosis of hip fracture, often within 24 hours. Having surgery right away can help shorten your stay in the hospital and may decrease pain and complications.1 But in some cases, surgery may be delayed for 1 to 2 days for treatment of other medical problems, such as heart or lung conditions, so that surgery will be less risky.
There are different types of surgery for hip fractures, depending on the location of the break, the position of the bone fragments, and your age. Surgery for a hip fracture may include one of the following:
- Internal fixation. Internal fixation involves stabilizing broken bones with surgical screws, rods, or plates. This type of surgery is usually for people who have fractures in which the bones can be properly aligned. See Hip Fracture Repair (Hip Pinning) for more information.
- Hip replacement surgery (arthroplasty). Arthroplasty involves replacing part or all of the joint with artificial (usually metal) parts. A partial hip replacement may be done to replace the broken upper part of the thighbone (femur) with artificial parts. In some cases, a total hip replacement can be done if the hip joint area was already damaged before the fracture by arthritis or an injury and the joint was not working correctly. Arthroplasty is often done for femoral neck fractures when the blood supply to the top of the thighbone is damaged and there is a chance that the bone might die (avascular necrosis). And arthroplasty is often done when the fractured bones cannot be properly aligned. See Hip Replacement Surgery for more information.
Reduction (getting the bone lined up correctly) and internal fixation (stabilizing broken bones) often are done on younger, active people. Hip replacement surgery often is done on older, less active adults. In deciding which of these methods to use for repairing a hip fracture, your surgeon will consider the type of fracture, your age and activity level, and also the possible trade-offs. Research on displaced hip fractures (where the bones are not aligned) shows that, in the long term, total hip replacements may need to be redone less often than internal fixation, but there is also more time in surgery, a greater chance of infection, and possibly a greater chance of death from hip-replacement complications.