Hip Fracture

fracture hip

Your hip joint is known as a ball and socket joint. The ball (head) of your femur (your thigh bone) fits into the socket of your pelvic bone to make your hip joint. This socket is called the acetabulum. There is a strong but flexible joint capsule that surrounds the hip joint. It helps to give stability to the joint and also produces a fluid called synovial fluid to give lubrication and help joint movement.

A hip fracture is another term for a broken hip. Your hip can break in different places. A hip fracture can be intracapsular (the bone within the joint capsule breaks) or extracapsular (the bone outside the joint capsule breaks). Your hip fracture can also be displaced or non-displaced. A displaced fracture is a fracture where the broken bones have moved out of their normal position. If the bone fragments have moved, they need to be put back (reduced) into their normal alignment. In a non-displaced fracture, the bone fragments, even though they are broken, are still aligned in their normal position.

What causes a hip fracture?

For older people, a hip fracture happens after a fall, usually just a fall from standing. A hip fracture can also occur in younger people. In these cases, it is more likely to be caused by trauma such as a car crash or a fall from a significant height.

What are the symptoms of a hip fracture?

If you fracture your hip you will be in a lot of pain around the injured hip. You will be unable to move your hip, stand or walk. You may also notice that the affected leg looks shorter and is turned outwards compared to your other leg.

What should I do if I am concerned that I have a hip fracture?

If you think that you may have fractured your hip, you need to get to hospital as soon as possible. You should also try to keep warm; covering up with a blanket may be helpful. Do not eat or drink anything while you are waiting for the ambulance to arrive.

What happens when I arrive at hospital?

You may be given some further pain relief medication, if needed, and sent for an X-ray to look at your hip. If you are dehydrated, you may be given some intravenous fluids (fluids via a drip into one of your veins). You will then usually be seen by an orthopaedic surgeon who will decide the best way to treat your hip fracture.

Occasionally, a hip fracture cannot be seen on a standard X-ray. You should then be offered a magnetic resonance imaging (MRI) scan, which gives more detailed information about the hip joint and soft tissue around it.

What is the treatment for a hip fracture?

Most people who have a hip fracture need surgery to fix the break in the bone. The type of surgery that you have can depend on where you have broken your hip bone (whether you have an intracapsular or extracapsular fracture) and also any underlying health problems that you may have.

Intracapsular hip fractures

  • Non-displaced fractures - usually, if you have a non-displaced intracapsular hip fracture, you will have an operation to join together and hold in place the broken bone fragments. This is known as internal fixation. Various devices can be used to provide the fixation, including screws, nails, plates and rods.
  • Displaced fractures - if you have a displaced intracapsular hip fracture, the bone fragments need to be re-aligned. They can then be fixed in place during an operation using internal fixation as described above. Sometimes, a hip replacement is used to treat a hip fracture. Hip replacement is also known as hip arthroplasty.

If you already have some hip joint disease - for example, osteoarthritis - and you are reasonably active and otherwise well, a total hip replacement may be a good option to treat a displaced intracapsular hip fracture.

Extracapsular hip fractures

An operation is also needed to treat extracapsular hip fractures. A special screw called a sliding hip screw is usually fitted to hold the bone fragments in place. Sometimes a nail (called an intramedullary nail) is used instead.

What happens after surgery for a hip fracture?

After surgery you will usually be taken from the operating theatre to an orthopaedic ward. You should be given pain relief as needed. Oxygen therapy (via a facemask or nasal cannulae) is usually needed. A drip to give you intravenous fluids will also be required by most people.

After surgery, you should be offered rehabilitation treatment, including physiotherapy, which should start on the day after surgery.

Treatment of any underlying osteoporosis

If you are an elderly person who has broken your hip, it is common for there to be underlying osteoporosis. Depending on your age, you may be referred for a special dual-energy X-ray absorptiometry (DEXA) bone scan to look for any evidence of bone thinning and osteoporosis. Treatment of osteoporosis is commonly with a medicine in the bisphosphonate group of medicines. These are often prescribed with dietary supplements of calcium and vitamin D.

Are there any possible complications after a hip fracture?

Complications that may occur in some people following a hip fracture include:

  • Infection
  • Deep vein thrombosis (DVT) - a DVT is a blood clot in a vein, usually a leg vein. It can be caused by immobility.
  • Blood loss.
  • Fracture nonunion - this is where the bone fragments of the fracture do not heal or join back together in the normal way.
  • Avascular necrosis - this is more likely if you have an intracapsular hip fracture. Without blood, the bone tissue can die. This can lead to problems including chronic pain around the hip.
  • Pressure ulcers - a pressure ulcer is an ulcerated area of skin caused by irritation and continuous pressure on part of your body.

What is the prognosis after a hip fracture?

This can depend to some extent on how fit you were before you broke your hip. However, even for the fittest of people, a hip fracture can mean that you do not regain your full mobility afterwards.

Can a hip fracture be prevented?

A fall in someone who has osteoporosis is a frequent cause of a hip fracture. Therefore, prevention of a hip fracture should be aimed at trying to prevent osteoporosis, at treating any osteoporosis that is already present, and at trying to prevent falls.

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